IMPROVE SRHR OUTCOMES OF YOUNG PEOPLE IN PNG

Sexual Reproductive Health Rights problems in Papua New Guinea (PNG) are complex as we have a multicultural society that is masculine, and multi-lingual.  Due to cultural norms, sociocultural beliefs, and social behavior and restrictions to openly discuss topics on sexuality and reproduction, these become service use barriers. 

Furthermore, information sharing and communication are difficult with differing tribal or cultural languages thus the health issues related to sexual health, and maternal health are high in PNG among the other Pacific Islanders, the Southeast Asia. In PNG, 85% of the population lives in rural areas where accessibility to essential services is limited. Accessibility to health services is also difficult as the health facilities are not designed to accommodate specific clients and their health needs. There are also other agents that become barriers to preventing access to SRHR services for young girls and women in society.

Because of the unavailability of SRHR services, unable to access SRHR services, and limited information and awareness, girls and women are the worst affected one way or the other by Sexual reproductive health issues in communities in PNG. Due to the unavailability, and inaccessibility of SRHR services, SRHR-related health issues are high in PNG among other Pacific Island nations in the region.

Our initiative will address the following problems and promote health, gender equality, equity, and livelihood in society, and address SRH-related issues in PNG;

1. Fertility rate = 4.4 births per woman

2. Pregnancy-related mortality rates = 205/1000

3. Teenage Pregnancy = 13% per 1,000 girls

4. Maternal mortality rate = 171/1000

5. Unsupervised births = 45.3%

6. Infant mortality rate = 33/1000 live births

Women aged 15 - 19 years account for 11% of all births globally, 95% occur in LMICs. The risk of maternal deaths for girls <16 years is double that of adult women. Adverse health outcomes from pregnancy-related among adolescents are high (high maternal morbidity, and maternal mortality). 

According to UNFPA reports, on average in PNG, women have four children, and the total fertility rate in PNG has remained high, ranging from 4.4 births per woman in rural areas to 3.6 births in urban areas. The Adolescent birth rate is high at 13%, 22% of 19 years old women have at least one child, and 6% have 2 more children. In addition, the infant Mortality rate is also high at 75/1000 live births in PNG. STIs and HIV/AIDS cases among young people are high in PNG at 0.85% among 15 to 49-year-olds.

All these issues contribute to limiting livelihood opportunities that perpetuate gender inequality and poverty. Our population in PNG has very limited information, and the little that one knows is very hard to share with another person. Therefore, having no knowledge and/or limited information on SRH, people suffer from the adverse effects of the practice of unhealthy sexual health activities in PNG. 

We will have a healthy population only when they take responsible approaches to their daily sexual health practices. Health education, awareness, and training to make people aware and understand sexual health and behave accordingly is a priority now to lower the high incidences of sexual and reproductive health issues in PNG.

Our solution aims to provide secure, fair, and culturally relevant sexual and reproductive health information to all childbearing age groups of girls and women, including boys and men. 

Because of the diverse multicultural society in PNG, one can not apply the same method of transferring health information used in one community to the other. Every society varies in language, cultural taboos, social norms, traditional beliefs, and others. Therefore, our solution will focus on our target population using mobile phone toll-free call systems to consult and counsel our clients on SRHR issues.

We will use two simple cost-effective methods easily adaptable and accessible by both users and providers;

1. Mobile Phone Troll-Free Calls - 24 hours, seven days a  week services

2. Use of Peer Educators and Influencers to conduct SRHR awareness and training to share SRHR information

Because of the poor transport systems, language barriers, poor economic status of the rural population, design of health centers, strong cultural influences, and local taboos that exist to prevent SRHR services accessibility, we will use the above methods.

The young population will have the freedom to be exposed to SRHR services freely. Communities expect people to be only married legally to talk about SRHR topics. Otherwise, young people are intimidated and stigmatized. Young girls are mostly affected by this traditional practice. In addition, health facilities are also not designed to accommodate such cases and provide privacy. Therefore our methods of delivering SRHR services target to address those barriers.

Mobile phone toll-free calls, and text messages method is very convenient and appropriate to address the above barriers and cover 90% or more of the target population. This method will allow the population to make calls on their own time when they need information or advice on SRHR. There will be no destruction or interference in their phone conversations. The conversation or the discussion will only be between the counselor and the caller. The counselor motivates the caller to provide information regarding the health needs as much as possible to draw a solution to address the need accordingly.

Phone text messages will also be allowed. The clients write out text messages regarding their health needs and the phone counselor responds by either replying by texting messages or making a phone call. This phone consultation is done one-on-one basis. 

These methods are identified to address the barriers that contribute to and/or prevent and/or limit accessibility to SRHR services by young girls and women. Our cultural background here in PNG is different from what is experienced in all other countries in the World. Therefore, based on our experiences and traditional background regarding sexual rights and sexuality in our communities. To meet and break these barriers to SRHR services, the methods under this solution are the most suitable which are culturally relevant, secure, and fair to improve SRHR outcomes. 

As local health (SRHR) experts, we know the barriers that exist to limit or/and reduce the accessibility to SRHR services resulting in high cases of maternal and infant mortality, and increased cases of STIs, and HIV/AIDS. Additionally, there are increased cases of teenage pregnancy in our target areas and other pregnancy-related preventable causes. 

The solution will serve the SRHR needs of young girls and women at child-bearing ages (12 - 45) years. Also, the young boys and men will be involved. Currently, there is limited health education and awareness of SRHR services due to different existing barriers as discussed above. Therefore, this solution will focus on young girls and women as these target groups are seen as weak in society and are overpowered and controlled by men. The target group has limited decision-making powers according to cultural practices in PNG. Consequently, they (girls and women) are the most affected population in society.

Due to all those existing barriers that prevent, limit, and or delay access to SRHR services by girls and women, SRHR outcomes are low or poor. SRHR outcome results in rural communities are worse than in urban areas as the target population does have some access to some SRHR services. However, in general, all SRHR outcomes/indicators are lower than expected.

In PNG, health services in rural communities are lower than in urban areas. Rural communities have stronger cultural beliefs and taboos than urban communities and are strongly bided. 

Health facilities are not designed to accommodate the specific needs of the population in all areas of PNG. Privacy of young girls and women is not provided and maintained thus they (girls and women) don't frequently nor routinely attend SRHR services at all health facilities in PNG. And importantly, health policies targeting SRHR services are not enforced and maintained by health authorities and health institutions. Consequently, the SRHR outcomes are low or poor.

To break the barriers and improve SRHR service outcomes/indicators, the PNGRWH team will focus on addressing and breaking the barriers through this solution through different activities targeting the methods of addressing the barriers. Our activities;

A. Our health education and health promotion officers will conduct group training and awareness on SRHR information for our target population in strategic locations in our target regions. Our girls and women must make informed life-dependent decisions on SRHR. The information must be transmitted using a language that is easy to understand, and a local dialect. 

B. Limited services/information on SRHR to all girls and women in rural communities, and even in urban areas. SRHR services are limited and/or poor in communities. This is due to poor communication and information infrastructure for the effective flow of public information. To defeat this, we will produce information pamphlets in a common language and distribute, and conduct awareness and training.

C. Culturally unacceptable to discuss sexuality in public as young people. To defeat this barrier, we will allow Toll-free mobile phone communication on SRHR services for consultation and services.

D. Not designed to meet young people's SRHR needs. To break this barrier to SRHR services, we will use our two solution methods listed elsewhere above in this challenge to improve the SRHR outcomes among our target population in PNG.

Primary schools, Higher schools, senior high schools, and rural communities target females between 12 to 45 years old and boys and men as well. There will be no boundaries and discrimination by sex and age in all communities.

PNGRWHA is a women-led NGO that uses local knowledge and experiences together with sexual health research backgrounds in public health. Women leaders in the group are from all different districts in the province that we focus on with our health programs. 

The women staff from those target districts who work together have identified SRH issues that cause health problems as reported from existing health information systems in PNG. Having seen the need to address the SRH issues has formed this PNGRWHA. Each woman/girl (staff) knows the local language, local culture, social issues, and local leaders, and will be the peer educators and be the change agents and/or influencers.

Each female staff member from a district in each of our five target provinces becomes the team leader when the program team visits the district. The team leader  (staff) is a local person who becomes the peer influencer and an advocate of the program. This process of having a local person as the team leader of the SRHR programs reduces any risks, addresses confusion, and promotes easy adaptation. 

Using local knowledge, it is easy to develop strategies that meet and work along cultural and socially relevant approaches. Importantly, local languages and dialects are used for understanding. The use of local language is important as PNG is a multi-lingual society with 780 plus different languages.

With the female staff member as a local person being the team leader of the program, arrangements with appropriate local community leaders/women leaders on the SRHR services program are easy. Active participation in the promotion of SRHR services in rural communities is a priority component of our programs. Male staff participants will only be seen as technical consultant staff in technical areas as the women leaders in all areas of our SRHR information sharing.

With the application of this process in our SRHR programs to all the target districts, every technical expert's contribution to SRHR information flows on with the team leader's perceptions as a local person. We have had no issues in our previous health programs and it will be the same with our SRHR project. We have Sexual Health Advocates, Midwives, pediatric nurses, environmental health officers, nutritionists, health educators, information and communication officers, and public health specialists on our teams with PNGRWHA. With this local and technical expertise on our program teams, and also based on our past experiences, we are confident of achieving better results with our SRHR services project.

Selected male advocates and influential male leaders are also required to be trained as male advocates on SRHR services. Male partners are part of, and/or root causes of the SRHR issues in communities. However, in this regard, as most of the girls and women are worst affected and impacted by the SRH issues, we target girls/women first, and men/boys are made part of the training where needed. Male community/district leaders and/or church leaders who are respected and more influential in the area are ideal candidates to be trained as male advocates.

Papua New Guinea Rural Women's Health Inc. works to ensure secure, fair, and culturally relevant maternal health care services to prevent and reduce maternal and infant mortality rates in PNG, thus SRHR is integrated into our programs as a main subject of concern. We are a proactive NGO that has already worked on Sexual Health and Reproductive Health in our rural communities covering districts in five (5) provinces in two regions (Momase Region and Highlands Region) in PNG. In these regions with an estimated population of more than five (5) million, we expect to cover ten (10) thousand girls and women in each district. Thus, our total target is fifty thousand (50,000.00) total girls and women. 

We see our solution as innovative, as we incorporate existing health initiatives and systems into our improved approaches with the use of a technology (mobile phone Toll-free calls) backup in our solution. 

We see our solution here as an innovative and effective approach to addressing SRHR needs as we will introduce the Toll-free mobile phone communication services and incorporate them into our routine health education and awareness programs with the SRHR information. 

This will be a new approach as we innovate our way of delivering health information and awareness information. After the awareness and information-sharing community training, we will allow one-on-one mobile phone consultation and counseling services. This will allow 100% privacy and accessibility to our SRHR information and counseling services from anywhere. This is at no cost to our clients, thus our clients will have all the freedom of speech to speak, ask any SRHR questions, and any other health-related questions. This is more convenient to our clients as an improved way of serving our clients from the current systems, and or processes of dealing with SRHR services seeking clients in our current health settings. 

Current health systems allow patients and clients to come to seek services at the health centers. Services are stationed at one spot, standard design to accommodate every client alike, and processes and procedures are common and standardized. Thus, our solution is designed specifically to address barriers in the current arrangement of SRHR services in the health systems. 

Our services will be unique from the current services as we take our SRHR services and other integrated health services closer to where the clients are in communities. For example, conducting mobile clinics, mobile SRHR services awareness and health promotion services, entertaining one-on-one mobile phone toll-free communication, and conducting private consultations and counseling services by phone and/or in person. These services are our initiatives designed to improve our solution to improve SRHR service outcomes. 

When our solution is seen to be effective and produce the desired results in our target communities, we are very sure the whole health system in the department will surely adapt to our initiative and make it a policy for public health programs in the country.

This initiative will motivate the public to make private calls for any health services counseling and advice as well as being more convenient for everyone. Our innovation in this regard to improve SRHR service, indicators will impact other health service programs and activities as well. As the technology evolves and is introduced into our systems and operations, the introduction of mobile phone SRHR consultation and counseling methods will change the way we do health business. Our results will influence policy development for the Health Department. 

The following results are expected with no thought;

A. Saves traveling time for clients

B. Reduces and/or saves costs for clients (traveling and health services costs)

C. Promotes client confidence and confidentiality 

D. Increased one-on-one phone client consultation

E. Reduces waiting time for clients at physical service locations

With these expected outcomes from our innovative services designed to meet SRHR outcomes, we are confident that the services are more convenient for people needing SRHR services based on our on-the-ground experiences and the influence that we know exists in our society in PNG. 

PNGRWHA is an NGO that is proactive in its work in rural communities in PNG. Having seen the maternal and infant health needs of girls and women of childbearing age groups in PNG, we have already started some work on SRHR in our communities and are progressing impactfully. Therefore having identified the SRHR services needs, we are working under this solution to achieve the following impact goals;

1. Reduced maternal mortality rates

2. Reduced STI, HIV/AIDS cases

3. Reduced Teenage pregnancy rates

4. Reduced infant mortality rates

5. Increased modern family planning users

6. Increased client consultation by mobile phone

7. Reduced other pregnancy-related preventable mortality rates

8. Saves clients' productive time and costs

With these identified impact goals, we expect to have both short-term and long-term impacts. 

Our short-term impacts are;

>  Increased client consultation and counseling by mobile phone

> Increased number of modern family planning users 

> Increase the number of people (girls and women) receiving SRHR information and training in target communities

> Increase the number of Village Health Volunteers to two (2) in every council ward in the target districts in the five (5) provinces and districts in the region

Our Mid-term impacts;

> Reduced teenage pregnancies in the target communities

> Reduced unwanted pregnancies in the areas targeted by our solution

> Reduced STIs, HIV & AIDS cases in target communities

> Decrease in the number of STI cases

> Increased awareness and training on SRHR with VHVs

Long-term Impacts;

> Reduced or decreased numbers of maternal mortality rates

> Decrease in infant mortality rates in target communities

> Decrease in the number of AIDS mortality cases

> Decrease in the number of all other pregnancy-related preventable mortality cases

> More girls complete school and are educated

Our aim is to achieve all the target Indicators by providing SRHR information and services to girls and women and their partners to realize the importance of accessing and using SRHR services. Being educated and informed of the SRHR information and availability of accessible services, the target population makes informed decisions in their sexual health lives. We break the barriers and create a link to accessing SRHR services freely and easily through our solution.

All our indicators will either increase or decrease by a certain percentage from the current figures. There will be improved health and well-being for every person in the communities we target in the regions in PNG, and impact on the lives of families, communities, and the whole nation. We expect to see lost time in production and other worthy activities saved from being affected and impacted by preventable SRHR-related health problems for productive activities. Our aim in this regard is to prevent preventable health problems, prevent deaths, and promote good health.

We are an NGO that is proactive in our health activities in our target communities. We know the health issues and related causes in our local communities. 

The health issues/problems identified and targeted in our solution regarding SRHR issues for improvement are both experienced and/or reported through other findings. Otherwise, the availability of valid data is limited due to poor data reporting, and management locally. However, some data published on the agenda are;

1. PNG remains the most HIV-affected country in the Pacific region with a prevalence rate of 0.7%, and the population aged 15 - 49 years accounts for a 0.89% prevalence rate in PNG. (PNG/UNAIDS reports, 2022).

2. According to PNG/UNAIDS reports, 2022: NCD and four Highlands provinces (Western Highlands - 1.3%, Jiwaka - 1.68%, EHP - 1.1%, and Madang- 0.62%) have high HIV prevalence rates in PNG among 15 - 49 years of age.

3. PNG has recorded one of the highest teenage pregnancy rates (65 births per 1,000 girls aged 15 - 19 years) among the Asia-Pacific countries, according to UNPF, 2022 reports.

Having identified the health issues associated with Sexual Reproductive Health in rural communities in PNG, the challenge team is ready to target activities and programs that will target to address every barrier that prevents sexually active girls and women, and their partners from accessing SRHR services. 

The solution will conduct continuous assessments and monitoring of the progress of the solution's impact through;

1. Client interviews, one-on-one during and after treatments and/or counseling

2. Client's partner assessment, interview, consultations on the progress and/or the impacts of the SRHR services on lives and communities

3. General community assessments, interviews, and data collection

4. Program partner assessment by involving them in expressing how they see the impacts of the solution, and finally

5. Monitoring and review of health data reported from local health facilities with health partners to see actual data collected on the program quarterly and annually. 

Weekly, fortnightly, and monthly progress assessments are done by the program team and partners to ensure progress is towards target impact areas and outcomes on SRHR.

Having done the health (SRHR) needs assessments and identified the issues associated with the lack of SRHR services, we plan to implement activities in this solution towards targeting the main accessibility barriers. Through the processes, we are to do continuous progress evaluations and monitor outcomes accordingly to ensure impacts are the tended impact indicators.

Through this process, we are very sure to meet our targets as the identified needs are very obvious. We will use the Logic Model and Program evaluation process to ensure we meet our targets. 

For example;

We have a situation to improve, so we plan to do something to improve the situation identified, we implement activities targeting the situation ( this will be through,.. Inputs, activities, specific project outputs), and this will give us Outcomes, To improve the situation (Impacts).

We are an NGO based in the rural communities in Papua New Guinea (PNG) that is a small and five years old organization. Thus we have seven (7) permanent staff with three (3) volunteers, so the total number is ten (10) staff.

We align our staff under two functions, Sexual Health and Reproductive Rights, and the Health Education and Promotion Branch.

Three (3) permanent staff under each program or function with two volunteers under SRHR, and one (1) volunteer under Health Education & Promotion. And one (1) program Director. We have fortnightly meetings to update ourselves on our work.

We have worked on the solution for four (4) years now after having identified the need to highlight the Sexual and Reproductive Health Rights of girls and women in a multicultural society in rural communities. 

Maternal and child health issues are complex in rural communities in PNG, thus SRHR issues are part of the whole social, economic, and health problems in society. PNG is a multi-cultural and multi-lingual society in the Pacific. 

In PNG, 75% of the total population of 8 million lives in rural communities, and 65% of the total population is illiterate. Every rural community is isolated by geography.

All our staff are locals who have had experiences and are part of the communities we implement our programs. Having seen and lived with the problems, we contributed to forming this organization to help solve the problems. 

Different provinces, districts, and tribal groups have varying cultures, language groups, social norms, and beliefs regarding different aspects of life in society. So Sexual and Reproductive Health Rights are shaped and guided by those norms and beliefs. We call them cultural Barriers to SRHR services. 

The issues are so complex and diverse in every community. thus we invite village chiefs and women group leaders in our work to share information vis-versa, learn the existing barriers in communities, and try to fit into norms that are beneficial. 

There are mirths and beliefs that prevent people from discussing topics on Sexual organs, and sexual intercourse activities openly. Therefore, girls' sexuality is discussed within girls alone, and boys/men's sexuality is between men/boys alone. It is not a public discussion point thus if found breaking the rules, one is punishable by paying compensation to community members. And also one will be cursed by society to bad happenings in one's life as rituals and myths. 

From this background in societies, we partner with Health Services organizations, Church groups, women's groups, youth group groups, schools, and community leaders/chiefs in our work. 

We conduct awareness and training, workshops, meetings, and consultations on Sexual Reproductive Health Rights (SRHR). Give them enough information SRHR and allow public discussions and also one-on-one to get community feedback. After having established a good understanding and the permissions given by all to have more information on SRHR, we conduct training on SRHR.

Basically emphasize and highlight the impacts of SRHR on the lives of girls and women. PNG is a masculinity society where men/boys are decision-makers. Thus SRHR decisions are also with the men/boys, limiting and/or denying the rights of girls/women. For example, boys/men decide when a couple should use the different types of family planning methods, when to have sex, and when girls/women should move out of their homes. Men/boys are not exposed to SRHR policies and the rights of women/girls to SRHR information and services.

With these backgrounds, we allow a mixture of a group of people in our training and other programs to allow public discussions, contribute ideas, and suggest options for the promotion of SRHR. Boys/men are allowed in training or workshops separately on their own to allow separate discussions, and girls/women too, and as a combined team workshops again too. These are comprehensive training at different levels to allow change in behaviors and attitudes. 

Finally, after having gone through all the information sharing and training, different groups of members of the community are allowed to suggest what are the best practices and/or options to take to improve access to SRHR services. And we allow them to make informed decisions that are good and beneficial to families and communities. Have learnt the importance of their Rights to be Human beings, they all have rights to live and participate equally and equity in communities.

PNGRWH will still apply the traditional processes and procedures of providing public health services aligned to and incorporating the Department of Health's National Health policies and guidelines. It will not be a Business Model or profit-making model, it will be a Social Services Model. Our solution will focus on;

1. Main client focus groups/population/client groups

2. Value of beneficiary or our focus population

3. Social Impacts/Measures of our services, and

4. What next to do based on the impact assessments/outcomes as surplus

Main client focus groups/population/client groups

Our focus is on the target focus group of the population (girls and women) aged 15 - 49 years who are at child-bearing ages. These are the groups who are mostly affected by Sexual Reproductive Health Rights (SRHR) issues in communities. Their (our focus population) health needs have been identified, and our aim is to meet these health needs effectively and appropriately to reveal the UN SDG, "Promote Universal Health Coverage, and Improve Health for All". Ensure every girl and woman's SRHR needs are met. Routine and effective assessments must be made to ensure efficiency in the delivery of our services. Changes and alterations to existing services must be made based on the client's needs and progress assessments.

Value of beneficiary or our focus population

Assessments and research are focused on the focus population. Meeting the client's needs and expectations is a priority.  The client's social needs, economic needs, spiritual needs, and cultural needs and expectations. These are some of the aspects of life that determine one to decide the type of health services, and when to seek health services (SRHR). The determinants of health services seeking, factors that influence one to seek, and/or not to seek health services. Thus, clients' value to various health services is vital in designing our SRHR services accordingly for an improved outcome or client coverage.

Social Impacts/Measures of our services

We will employ frequent and routine program assessments on the progress, the client's satisfaction, and overall impact. Assessment results/findings will assist us in making amendments and alternations where necessary to our SRHR activities accordingly to meet clients' specific health needs. 

Client-based assessments on the impacts, general public interviews, and their partners' views and overview of the SRHR services experienced in the communities. From the findings, we will improve and ensure targets are met as planned. 

What next to do based on the impact assessments/outcomes as surplus

From our assessment analysis and reports, the social impacts of our solution on improving SRHR outcomes, we will share the entire project reports with all our service partners, stakeholders, and all client groups to either celebrate the improved outcomes or find alternatives in the delivery of SRHR services to make or produce positive impacts in the lives of our population.

Our aim in this solution is to sell our products and services (health products in this solution) to the Department of Health to buy or adopt into its health Policies and systems to apply in all communities throughout the nation. We are very convinced that the program's impact results will attract the attention of the Health Authorities to adopt and institutionalize the SRHR program.

In Papua New Guinea (PNG), eighty-five (85%) percent of the healthcare services are provided to our population free. The remaining are provided by a few private healthcare providers at a lower price than our people can not afford to pay as their income is very low or none.

The demand for health services is high but the effort to meet the costs of the healthcare services is very low. Having seen the need for the services, the government of PNG pays for and delivers the services free and/or at a very small cost in partnership with stakeholders and service organizations.

The government establishes and/or creates health policies, systems, structures, and laws that drive both the service provider and the consumers of health services. These approaches guide and ensure efficiency and effective delivery and its outcomes. This is unlike in most of the developed nations where the service user pays for the health services. Thus the government of PNG is responsible for the sustainability of the total costs of the health services industry, year in-year-out. So the PNG government subsidizes the fees, even with the stakeholder partners that provide health care services. 

Having this healthcare system in place in PNG, PNGRWHA will not be any exception in any way with its management and delivery of Sexual Reproductive Health Rights (SRHR) services in this regard. All our anticipated (activities) services will be channeled through the existing health systems and the partnership systems for the sustainability of our services. 

This table outlines a simple model of our service delivery as we will not be charging high user fees and prices for our services. 

Sexual Reproductive Health Rights services for young people in PNG.

            Model of sexual healthcare services delivery in PNG

Free–for–Service

+ Selling social services directly to clients, and or third-party stakeholders.

+ Providing access to services for those who cannot afford them.

+ Membership stakeholders or partner organizations and site health clinics.

+ Special health care programs targeting specific health needs.

+ Establishing appropriate fee structures based on the needs and benefits.

+ Create service systems, laws, and policies to lower costs and improve efficiencies and outcomes.

Therefore, all our focus is on the needs of the clients rather than the profit and or the income part of our services. This is a routine and regular practice in our health systems in PNG. thus we will engage in the same service process to see our target population benefit and improve their sexual and reproductive health outcomes. Finally, progress towards incorporating our programs into the existing health systems and public health programs in PNG with our programs, thus our solution to this challenge will be easily factored in and incorporated.