I have seen many improvements in child health in Papua New Guinea in the 15 years that I have been working with the health system there, led by committed young paediatricians who have designed and implemented a national plan for child health.
As a member of the National Child Health Advisory Committee and the Paediatric Society, I was part of a review held in September to assess whether this plan is on track. At that meeting, leaders in child health presented strong evidence of progress in the most challenging of problems.
Immunisation is one of the most cost-effective ways to save lives. For vaccines to reach every district, the Health Department has identified the 20 lowest-performing and most isolated areas and completed a stocktake of childhood immunisations, services and vaccine supplies. AusAID has provided $1 million to implement the Reaching Every District initiative in concert with support from WHO and UNICEF. The Health Department is also partnering with AusAID, WHO and UNICEF to provide mass vaccination across the whole country, against measles and polio. With revitalised services for the hardest to reach, this is already making a difference.
The Haemophilus influenzae vaccine against pneumonia and meningitis was introduced successfully in 2008, and the pneumococcal vaccine is to be introduced in 2014. The Health Department is also active in prevention of pneumonia through improving nutrition (including breastfeeding), reducing indoor air pollution, encouraging hand-washing and early treatment. Treatment programs that introduced oxygen therapy have seen a 35 per cent reduction in death from pneumonia. Pneumonia, diarrhoea and neonatal conditions are the major causes of hospitalisation and child deaths in PNG.
Neonatal health is a continuing priority; while child and infant mortality has fallen in the last decade, neonatal mortality remains static at 28-30 per 1000 live births. As part of an effort to implement better standards of neonatal care, the health department has assessed five hospitals in the Highlands district and established a model for quality district-level services.
Malaria is no longer one of the top three causes of hospital admission for children due to the widespread use of insecticide-treated bed nets. The health department acknowledges that maintaining this program beyond the Global Fund to Fight AIDS, Tuberculosis and Malaria will be a challenge.
With support from the Clinton Health Access Initiative, rural clinics are now HIV testing, counselling and treatment centres. Effective programs to prevent transmission of HIV from parents to children have seen the rate of infection to newborns from mothers who have HIV falling from 30 per cent in 2007 to 15 per cent in 2012, meaning many fewer children are born with HIV.
Tuberculosis treatment through a fixed-dose combination of medications has been introduced nationally; however, access to medication in health centres is currently inadequate. Major policy changes were recommended from this meeting.
Information about common causes of hospital admissions and deaths has improved over the last three years with the introduction of a new reporting system. During this period, 36,000 admissions from 15 hospitals have been documented in detail. This information will assist the Health Department to prioritise clinical and public health programs and to track future progress in child health.
A dedicated and trained health workforce has achieved improvements in child health but more training facilities for child health nurses and community health workers are needed to provide sufficient numbers. AusAID is helping to develop a skilled health workforce. They have provided invaluable support to the University of PNG School of Medicine and Health Sciences for a decade, and are providing scholarships to support the training of nurses, midwives and community health workers.
Many challenges need to be addressed in the coming years. Long-term development depends on national coordination of programs and services for child health, implementing programs and services in all provinces, a good understanding by provincial health officials, and monitoring the scale and quality of implementation. Maternal health is a large determinant of child survival, and there is much to do to reduce maternal deaths and improve family planning. Increased investment in maternal and child health, matching the growing wealth of the country, is an urgent priority. Factors outside the health sector, particularly education, agriculture and environmental health will be major determinants of long-term progress.
Child health in PNG is in good hands. We hope the economic opportunities of the next decade will put much greater resources into improving children’s health, and that a more equitable spread of opportunity will enable parents to better care for their children.
About the author: Professor Trevor Duke
Professor Trevor Duke is the Director of the Centre for International Child Health, University of Melbourne, and Adjunct Professor of Child Health, School of Medicine & Health Sciences, University of PNG.
The Centre for International Child Health receives funding from AusAID through Compass: Women’s and Children’s Health Knowledge Hub. Compass is a partnership between the Burnet Institute, Menzies School of Health Research and the Centre for International Child Health, University of Melbourne.