Implementing improvements in sexual, reproductive and maternal health in the Highlands of Papua New Guinea

CARE International has been working in Papua New Guinea’s Highlands to improve sexual, reproductive and maternal health outcomes.  The Highlands Sexual, Reproductive and Maternal Health Project has drawn to a close with encouraging results and useful lessons about working on sensitive health topics.

In rural Papua New Guinea, one in 25 women dies of pregnancy related causes and 52 babies in every 1,000 die before their first birthday.  The Project sought to address these statistics, recognising that they are only partly attributable to structural problems within the health system.  Communities not understanding sexual, reproductive, and maternal health issues, not using health services, and not demanding better service also contribute to these poor health outcomes.

The project approached the issues in three integrated ways.

First, it promoted attitudinal and behavioural change to drive community demand for health services.  A series of participatory, human rights-based workshops helped communities to challenge negative gender norms and behaviours related to poor health and take ownership of their own healthcare. Over half of the most significant change stories shared by participants indicated partners were sharing household workloads more equitably after the workshops.  Almost half indicated that families were discussing family planning and a quarter indicated that instances of forced sex were declining.

In Siaka, community leaders agreed to end a custom that previously prevented women from delivering babies in places where a man might go – such as the health centre. As a result, just a few weeks later, the first baby was delivered in the aid post that had been built in 1982.  By November 2017, 24 babies had been delivered in the safe environment of the aid post.

Secondly, the project developed the health workforce through Village Health Volunteer and health worker training.  The project mentored four health workers over two years and trained 50 others in acute malnutrition, effective vaccine management, and emergency obstetrics.

Village Health Volunteers are part of the national health system and are positioned to facilitate sustainable, long-term improvements to community health. CARE supported 63 women and men to undertake the National Department of Health training, with 44 completing the course.  Modules included healthy families, safe motherhood, and first aid.

Practical training in safe motherhood was completed by 30 of these volunteers.  They carried out 98 action plans, leading to increased community knowledge on the importance of antenatal checks, nutrition during pregnancy, and reducing workloads of pregnant women.

Healthy Islands training was given to 14 of these volunteers to become Village Health Promoters.  Through their 57 action plans, these volunteers supported communities to implement hygiene and sanitation initiatives.

Finally, the project strengthened health systems through infrastructure support and outreach clinic visits. Facilities at four health facilities were upgraded.  The project also vaccinated 6,744 children, screened 2,733 for malnutrition, and provided family planning advice to over 200 people.

Lessons from the project include the importance of challenging harmful gender and cultural norms that prevent women and children from accessing services and care. Even though facilities had been built and volunteers trained, until a taboo was overturned, no babies were being born at the Siaka health post.  Engaging at the family, as well as community level, is also important in bringing about long-term change.

The utility of Volunteer Health Workers was highlighted.  There is scope to use this existing and respected network of trained volunteers to run trainings (like the workshop series).

Finally, whilst it is important to drive community demand for health services from the bottom up and work with government from top down, it is also crucial to support the health workers.  They are at the nexus of these two processes and on whose work success ultimately depends.

Read the report and Community Workshop Series resource: