Big Need, Big Responsibility: Empowering Papua New Guinea’s Frontline Health Workers Towards Universal Health Coverage

Clare Ponahai’s mother is a nurse. Growing up in Papua New Guinea (PNG) she was acutely aware of the important role frontline health workers play in her country. 

“There's a big need, with nurses especially,” Sister Clare says. “Every time I look at my mum, I think [she] is my mentor. She's the one that made me want to become a nurse.”

Following in her mother’s footsteps, Sr. Clare now oversees the inpatient service at Napapar Health Centre, a 36-bed facility servicing a catchment area of 22,500 people in East New Britain province.

While Sr. Clare is busy receiving and treating patients in Napapar, in other parts of the country, many of PNG’s population of over 11.7 million people are unable to easily access quality healthcare services, particularly in rural areas. According to the National Statistical Office, only around half of all pregnant women receive the minimum number of antenatal care check-ups, and child immunization rates are extremely low and declining. In 2018, only 35% of children had received all basic vaccinations. As a result, the nation has one of the highest maternal and child mortality rates in the region. 

To turn this around, the government is implementing the US$30 million IMPACT Health project with support from the World Bank. The project aims to improve the delivery of services on the ground, ensuring medicine, equipment and expertise reach the ‘frontlines’ of health in rural areas. Through the Advance Universal Health Coverage Trust Fund, the Australian Government has also enabled valuable technical support and advice.

With East New Britain acting as a pilot province, an initiative proving to be successful is the rollout of a supervisory checklist to health centers which is helping Provincial Health Authority officials collect information about the quality of services being offered, equipment being used, infrastructure, and staffing needs. 

Florence Wanawa is a health officer at Napapar with Sr. Clare. When she was first asked to fill in the checklist, she was a little unsure. 

“When I first saw it, I freaked out. I thought that maybe I was not doing the right thing. Then I learned that the checklist is done to improve the facility, [if] we haven't been doing something that we're supposed to do … we have to improve from that. And that's what they're doing now,” says Florence. 

Supportive supervision is an important way to help improve the delivery of health services, yet more than one third of PNG’s health centers received no supervisory visits in 2016. Poor communication infrastructure also makes it difficult for frontline health workers to provide feedback to decision makers. The supervisory checklist is improving both supervision and communication, and Florence now sees it as a necessary tool to facilitate the funding and support that her health center needs. 

“This checklist is a guide for us to keep up [with] what we are supposed to do,” Florence says. “It's a good thing.” 

Her colleague Julie Fonataba, a midwife for 25 years, agrees. 

“The supervisory checklist made a great change. The first time they came, I think we scored a low percentage. After the second time they sat with us and looked at the respective areas. And we improved in fulfilling all the respective areas,” says Julie. 

Norman Vakore is the Director of Public Health in East New Britain’s Provincial Health Authority. He has been involved in the roll-out of the supervisory checklist and is already using the data to improve services. “So many issues have been identified … and that's why I say it's a very good tool for us. As a manager, I use that information to really improve addressing some of those [issues].” 

“We started to pick up some issues around the kind of infrastructure that we put up. We had not provided easy access for people living with disabilities to come in. We are looking at trying to make some changes or consider this when we are putting up infrastructure now.” 

The information from the supervisory checklist also feeds into a digital provincial health dashboard—along with reports on other healthcare indicators—which is being used by the Provincial Health Authority Board to inform their decision making. 

“The best [thing] that we can provide is the correct information to boards, so that the right decision can be made,” says Mr. Vakore. “Sometime back, we haven’t had the opportunity to get this kind of information on time. [Now] authorities can look at some long-standing issues and address them immediately.”

Chief Executive of East New Britain’s Public Health Authority, Dr. Ako Yap agrees that data collated through the dashboard makes identifying issues and trends much easier. 

“At the push of a button…you get all the answers you want,” says Dr. Yap. “It's a game changer for us because it'll analyze and give you the reason why that center is not performing well. And you can provide a resource to improve that indicator. So that is really good.”

Following the success of the supervisory checklist in East New Britain, work is now underway to roll it out across the country. 

Dr. Dora Lenturut is the Acting Deputy Secretary, National Health Service Standards at the National Department of Health. “The plan of the National Department of Health is to make sure all 22 public health authorities have access to the supervisory checklist,” she explains. “[We intend] to capture all rural health facilities on digital platforms so we can monitor and [have] visibility of the activities at the National Department of Health.” 

With improved data collection and supervision lifting the standard of healthcare in rural communities, it is hoped that all children in PNG will get the chance to grow up to be strong and healthy. Perhaps they will even follow in the footsteps of Sr. Clare, Florence and Julie and become frontline health workers, caring for their community too.