Skip to main content

Advertisement

SpringerLink
Log in

Accelerating Maternal and Child Health Gains in Papua New Guinea: Modelled Predictions from Closing the Equity Gap Using LiST

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Background

Many priority countries in the countdown to the millennium development goals deadline are lagging in progress towards maternal and child health (MCH) targets. Papua New Guinea (PNG) is one such country beset by challenges of geographical inaccessibility, inequity and health system weakness. Several countries, however, have made progress through focused initiatives which align with the burden of disease and overcome specific inequities. This study identifies the potential impact on maternal and child mortality through increased coverage of prioritised interventions within the PNG health system.

Methods

The burden of disease and health system environment of PNG was documented to inform prioritised MCH interventions at community, outreach, and clinical levels. Potential reductions in maternal and child mortality through increased intervention coverage to close the geographical equity gap were estimated with the lives saved tool.

Results

A set community-level interventions, with highest feasibility, would yield significant reductions in newborn and child mortality. Adding the outreach group delivers gains for maternal mortality, particularly through family planning. The clinical services group of interventions demands greater investment but are essential to reach MCH targets. Cumulatively, the increased coverage is estimated to reduce the rates of under-five mortality by 19 %, neonatal mortality by 26 %, maternal mortality ratio by 10 % and maternal mortality by 33 %.

Conclusions

Modest investments in health systems focused on disadvantaged populations can accelerate progress in maternal and child survival even in fragile health systems like PNG. The critical approach may be to target interventions and implementation appropriately to the sensitive context of lagging countries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. World Health Organization, United Nations Children’s Fund. (2013). Countdown to 2015: Accountability for maternal, newborn & child survival. The 2013 update. Geneva, Switzerland: World Health Organization.

    Google Scholar 

  2. United Nations Children’s Fund (UNICEF). (2014). The State of the World’s Children 2014 In Numbers: Every child counts. New York, USA: UNICEF.

    Google Scholar 

  3. Mola, G., & Kirby, B. (2013). Discrepancies between national maternal mortality data and international estimates: The experience of Papua New Guinea. Reproductive Health Matters, 21(42), 191–202.

    Article  PubMed  Google Scholar 

  4. National Department of Health. (2010). National Health Plan 2011–2020. Port Moresby, PNG: Department of Health, Papua New Guinea.

    Google Scholar 

  5. Bauze, A., Tran, T., Huong Nguyen, K., Firth, S., Jimenez-Soto, E., Dwyer-Lindgren, L., et al. (2012). Equity and geography: The case of child mortality in Papua New Guinea. PLoS One, 7(5), e37861.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. National Department of Health. (2009). Ministerial taskforce on maternal health in Papua New Guinea. Port Moresby, PNG: Government of Papua New Guinea.

    Google Scholar 

  7. The World Bank Group. (2014). Papua New Guinea: The World Bank Group Country Survey 2014. Washington, DC: The World Bank.

    Google Scholar 

  8. Awofeso, N., & Rammohan, A. (2010). Maternal mortality reduction in Papua New Guinea: Millennium development goal worth achieving, but what will it take? Asia Pacific Journal of Health Management, 5(2), 22–29.

    Google Scholar 

  9. The Partnership for Maternal Newborn & Child Health (PMNCH). (2011). A global review of the key interventions related to reproductive, maternal, newborn and child health (p. 2011). Geneva, Switzerland: PMNCH.

    Google Scholar 

  10. Bhutta, Z., Hafeez, A., Rizvi, A., Ali, N., Khan, A., Ahmad, F., et al. (2013). Health transitions in Pakistan 2: Reproductive, maternal, newborn, and child health in Pakistan: Challenges and opportunities. Lancet, 381(9884), 2207–2218.

    Article  PubMed  Google Scholar 

  11. Ruhago, G., Ngalesoni, F., & Norheim, O. (2012). Addressing inequity to achieve the maternal and child health millennium development goals: Looking beyond averages. BMC Public Health, 12, 1119.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Bhutta, Z., Das, J., Walker, N., Rizvi, A., Campbell, H., Rudan, I., et al. (2013). Interventions to address deaths from childhood pneumonia and diarrhoea equitably: What works and at what cost? Lancet, 381(9875), 1417–1429.

    Article  PubMed  Google Scholar 

  13. Walker, N., Yenokyan, G., Friberg, I., & Bryce, J. (2013). Patterns in coverage of maternal, newborn, and child health interventions: Projections of neonatal and under-5 mortality to 2035. Lancet, 382(9897), 1029–1038.

    Article  PubMed  Google Scholar 

  14. Institute for Health Metrics and Evaluation (IHME). (2010). Global burden of disease profiles: Papua New Guinea. Seattle, USA: IHME.

    Google Scholar 

  15. World Health Organization. (2010). Monitoring the building blocks of health systems: A handbook of indicators and their measurement strategies. Geneva, Switzerland: World Health Organization.

    Google Scholar 

  16. Johns Hopkins Bloomberg School of Public Health. (2013). LiST: Lives saved tool. Baltimore, USA: JHSPH [September 2013]. http://www.jhsph.edu/departments/international-health/centers-and-institutes/institute-for-international-programs/list/

  17. DeCormier-Plosky, W., Friberg, I., Winfrey, B., & Stover, J. (2009). Lives saved tool: A computer program for making child and maternal survival projections. USA: Johns Hopkins Bloomberg School.

    Google Scholar 

  18. Jamison, D., Shahid-Salles, S., Jamison, J., Lawn, J., & Zupan, J. (2006). Incorporating deaths near the time of birth into estimates of the global burden of disease. Washington, DC: The World Bank and the National Institutes of Health.

    Google Scholar 

  19. Jones, G., Steketee, R., Black, R., Bhutta, Z., & Morris, S. (2003). How many child deaths can we prevent this year? Lancet, 362(9377), 65–71.

    Article  PubMed  Google Scholar 

  20. Darmstadt, G., Bhutta, Z., Cousens, S., Adam, T., & Walker, N. (2005). Evidence-based, cost-effective interventions: How many newborn babies can we save? Lancet, 365, 977–988.

    Article  PubMed  Google Scholar 

  21. Lawn, J., Wilczynska-Ketende, K., & Cousens, S. (2006). Estimating the causes of 4 million neonatal deaths in the year 2000. International Journal of Epidemiology, 35(3), 706–718.

    Article  PubMed  Google Scholar 

  22. Campbell, O., & Graham, W. (2006). Strategies for reducing maternal mortality: Getting on with what works. Lancet, 368, 1284–1299.

    Article  PubMed  Google Scholar 

  23. Boschi-Pinto, C., Young, M., & Black, R. (2010). The Child Health Epidemiology Reference Group reviews of the effectiveness of interventions to reduce maternal, neonatal and child mortality. International Journal of Epidemiology, 39(Suppl 1), i3–i6.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Guyatt, G., Oxman, A., Vist, G., Kunz, R., Falck-ytter, Y., Alonso-Coello, P., et al. (2008). GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 336, 924.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Lozano, R., Naghavi, M., Foreman, K., Lim, S., Shibuya, K., Aboyans, V., et al. (2012). Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380(9859), 2095–2128.

    Article  PubMed  Google Scholar 

  26. Morrison, A., Raju, D., & Sinha, N. (2007). Gender equality, poverty and economic growth. Washington, DC: The World Bank.

    Book  Google Scholar 

  27. National Department of Health. (2011). Health sector performance annual review: 2006–2010 national report. Port Moresby, PNG: National Department of Health, Papua New Guinea.

    Google Scholar 

  28. The Child Health Advisory Committee, PNG National Department of Health. (2010). Papua New Guinea annual report on child morbidity and mortality. Port Moresby, PNG: National Department of Health, Papua New Guinea.

    Google Scholar 

  29. Thomason, J., Mulou, N., & Bass, C. (1994). User charges for rural health services in Papua New Guinea. Social Science and Medicine, 39(8), 1105–1115.

    Article  CAS  PubMed  Google Scholar 

  30. United Nations Population Fund (UNFPA). (2010). Country profile: Papua New Guinea (p. 2010). New York City, USA: UNFPA.

    Google Scholar 

  31. United Nations Population Fund (UNFPA). (2011). State of the world’s midwifery: Papua New Guinea. New York City, USA: UNFPA.

    Google Scholar 

  32. WHO Western Pacific Regional Office. (2011). Country health information profile: Papua New Guinea health databank. Geneva, Switzerland: WHO.

    Google Scholar 

  33. World Bank. (2013). Papua New Guinea overview. Washington, DC: World Bank [September 24, 2013]. http://www.worldbank.org/en/country/png/overview

  34. World Health Organization Western Pacific Region. (2013). Health profile—Papua New Guinea: Health financing. Geneva, Switzerland: WHO.

    Google Scholar 

  35. AusAID. (2010). Australia-PNG health delivery strategy 2011–2015: What development outcomes will Australia contribute to? Canberra: Australian Department of Foreign Affairs and Trade.

  36. Dawson, A., Howes, T., Gray, N., & Kennedy, E. (2011). Human resources for health in maternal, neonatal and reproductive health at community level: A profile of Papua New Guinea. Sydney, Australia: Human Resources for Health Knowledge Hub University of NSW, Burnet Institute.

    Google Scholar 

  37. United Nations Children’s Fund (UNICEF). (2013). Country statistics-PNG. New York: UNICEF [Auguest 28, 2013]. http://www.unicef.org/infobycountry/papuang_statistics.html

  38. UNAIDS. (2012). Global AIDS report 2012—Country progress report: Papua New Guinea. Port Moresby, PNG UNAIDS.

  39. UNFPA. (2011). State of the World’s Midwifery: Papua New Guinea.

  40. National Statistics Office. (1997). Papua New Guinea Demographic and Health Survey 1996. Port Moresby, PNG: National Statistics Office, Papua New Guinea.

    Google Scholar 

  41. WHO Western Pacific Regional Office. (2012). HIV and sexually transmitted infections in the Western Pacific Region, 2000–2010. Geneva, Switzerland: WHO.

    Google Scholar 

  42. UNAIDS. (2013). Global report: UNAIDS report on the global AIDS epidemic 2013. Geneva, Switzerland: UNAIDS.

    Google Scholar 

  43. Lozano, R., Wang, H., Foreman, K., Rajaratnam, L., Naghavi, M., Marcus, J., et al. (2011). Progress towards millennium development goals 4 and 5 on maternal and child mortality: An updated systematic analysis. Lancet, 378(9797), 1139–1165.

    Article  PubMed  Google Scholar 

  44. Sanga, K., de Costa, C., & Mola, G. (2010). A review of maternal deaths at Goroka General Hospital, Papua New Guinea 2005–2008. Australian and New Zealand Journal of Obstetrics and Gynaecology, 50(1), 21–24.

    Article  PubMed  Google Scholar 

  45. Jayanthan, J., Irava, W., Anuranga, C., & Rannan-Eliya, R. (2012). The impact of out-of-pocket expenditures on families and barriers to use of maternal and child health services in Papua New Guinea. Manila, The Philippines: Asian Development Bank.

    Google Scholar 

  46. Asian Development Bank, AusAID, World Bank. (2007). World bank strategic direction for human development in Papua New Guinea. Washington, DC: The World Bank.

    Google Scholar 

  47. McNee, A. (2011). Policy brief—medical supplies reform in Papua New Guinea: Some conceptual and historical lessons. Canberra, Australia: Development Policy Centre, Crawford School, ANU.

    Google Scholar 

  48. World Health Organization. (2013). Regional framework for reproductive health in the Western Pacific Region. Geneva, Switzerland: WHO.

    Google Scholar 

  49. Wang, H., Liddell, C. A., Coates, M. M., Mooney, M. D., Levitz, C. E., Schumacher, A. E., et al. (2014). Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet, 384(9947), 957–979.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Kassebaum, N., Bertozzi-Villa, A., Coggeshall, M., Shackelford, K., Steiner, C., Heuton, K., et al. (2014). Global, regional, and national levels and causes of maternal mortality during 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet, 384(9947), 980–1004.

    Article  PubMed Central  PubMed  Google Scholar 

  51. Duke, T., Kado, J., Auto, J., Amini, J., & Gilbert, K. (2015). Closing the gaps in child health in the Pacific: An achievable goal in the next 20 years. Journal of Paediatrics and Child Health, 51(1), 54–60.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Department of Health, Child Health Advisory Committee. (2014). Child Morbidity and Mortality Annual Report 2013. Port Moresby, PNG: National Department of Health, Papua New Guinea, Paediatric Society, Papua New Guinea.

    Google Scholar 

  53. Byrne, A., & Morgan, C. (2011). Improving maternal, newborn and child health in Papua New Guinea through family and community health care. Melbourne, Australia: Burnet Institute, Women’s and Children’s Health Knowledge Hub, World Vision.

    Google Scholar 

  54. Bhutta, S., Darmstadt, G., Hasan, B., & Haws, R. (2005). Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: A review of the evidence. Pediatrics, 115(2), 519–617.

    PubMed  Google Scholar 

  55. Lewin, S., Munabi-Babigumira, S., Glenton, C., Daniels, K., Bosch-Capblanch, X., van Wyk, B., et al. (2010). Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database of Systematic Reviews, 17(3), 004015.

    Google Scholar 

  56. Somerville, C. (2012). PNG Government recognise potential of VHVs. Melbourne, Australia: Burnet Institute.

    Google Scholar 

  57. Davis, J., Durrant, K., Morgan, C., & Byrne, A. (2013). Community actions and community-health systems linkages for improved maternal and newborn health: A synthesis of the evidence. Melbourne, Australia: Burnet Institute, WHO Western Pacific Region.

    Google Scholar 

  58. Papua New Guinea National Department of Health. (2008). Institutional reform the need for change, education and training, demand and supply, the workforce, workers by provincial and hospital services. Port Morseby: Department of Health.

    Google Scholar 

  59. Countdown 2008 Equity Analysis Group. (2008). Mind the gap: equity and trends in coverage of maternal, newborn, and child health services in 54 Countdown countries. Lancet, 371(9620), 1259–1267.

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank project staff at School of Public Health, The University of Queensland for their assistance in the development of this paper.

Author information

Authors and Affiliations

  1. The Nossal Institute for Global Health, The University of Melbourne, Alan Gilbert Building, 161 Barry Street, Carlton, VIC, 3010, Australia

    Abbey Byrne

  2. School of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Level 2, Public Health Building, Herston Road, Herston, QLD, 4006, Australia

    Abbey Byrne, Andrew Hodge & Eliana Jimenez-Soto

Authors
  1. Abbey Byrne
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew Hodge
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eliana Jimenez-Soto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Abbey Byrne.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 31 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Byrne, A., Hodge, A. & Jimenez-Soto, E. Accelerating Maternal and Child Health Gains in Papua New Guinea: Modelled Predictions from Closing the Equity Gap Using LiST. Matern Child Health J 19, 2429–2437 (2015). https://doi.org/10.1007/s10995-015-1762-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-015-1762-6

Keywords

Search

Navigation