Introduction
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| Picture courtesy of traditional child birth |
Maternal health is the health of women during pregnancy,
childbirth, and postpartum period. It encompasses the health care
dimensions of family planning, preconception, prenatal, and postnatal care in
order to reduce maternal morbidity and mortality(Maternal health, 2015) Maternal health is one of the leading cause
of death in the world (WHO, 2009).
It is an injustice death given how preventive these deaths are. According to WHO, maternal mortality rate is
scaled down by three quarters between 1990 and 2015 as assumed in Millennium
Development Goal. However, PNG has opposed the trend by recording a worse
maternal and infant mortality rate in the Asia Pacific, substantiated by the
following statistics (HDR Report, 2014):
- 98 deaths per 10000 live births;
- Women in PNG are particularly disadvantaged, as evidenced by poor maternal health; and lack of access to family planning. The maternal mortality ratio is 230 per 100,000;
- Population Services International estimate that least five women die in childbirth every day;
- 42% of women do not give birth at a health facility or hospital;
- 22% of pregnant women do not receive any formal antenatal care;
- 35.7% of women use contraception
- 10% of all deaths are due to perinatal conditions
Addressing Maternal Health issue is one the MDGs as agreed by 189
countries in 2000. And of the eight goals, goal five is centered to improve
maternal health, thus PNG localizing into its NHP2011-2020 goal number five
(5). To achieve this goal is very complex, constrained by factors such as;
insufficient funds, inaccessibility to reproductive health, lack of
sociocultural awareness and irregularities in health information system (Simwaka et al, 2005). Despite NDoH publish PHA as a tool to address
the NHP-eradicating Maternal Health problems and other KRAs in PNG.
Particularly PHA helps to achieve four objectives of maternal health-KRA5. The
NHP2011-2020 emphasis health as everyone’s business, requiring collective
efforts from private public sectors and international communities to realized
its overall goal.
How PHA improve NHP-KRA5
PHAA2007 was established by the
NDoH combining dual health
system coordinated by Minister of Health called centralized health care system.
Basically, PHA is commissioned to help deliver public and curative health
services. Indeed, a new concept in PNG but it is widely practiced in other
countries like France, USA,
Japan and Cuba that ranked at the top of health care ladder (Wilson, 2010). Families from rural Mexico receive
health care from centralized clinics run by the federal government pay up to 30
percent less in out-of-pocket expenses and utilize preventive services more
often than those families who access decentralized clinics run by states (UCLA School of Public Health, 2010). Centralization may lower costs by reducing duplication of health care oriented roles. It provides health care opportunities
that can be easily accessed.
The PHA comprises nine
(9) board members spear headed by CEO, who manages health function, grants and
health workers. And so when Southern Highlands Province gains PHA, there are two links under PHAA 2007
namely; partnership with NGO and
one line of reporting system (communication channel) between PHA and NDoH that are
significant in improving maternal health.
(1) Partnership with NGOs (Churches)
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| Picture courtesy of Susu Mama worker in Goroka Hospital |
Under section 12(4c) and section (13) of PHAA, allows contract with NGO’s (church) to work together to improve maternal health in the province. NGO’s like Susu Mama is working closely with Hospitals to address maternal health issues. Susu mama is a NGO operating in PNG for 30 years but since then there haven’t been much recognition from Government. However with PHA in place, Susu Mama has now gained recognition, with health facilities in Goroka, Lae and Mt Hagen providing integrated Family and Youth outreach health services at urban clinics, rural and settlements. It integrates with E.H.P and W.H.P. PHA to improve family planning, sexual and reproductive health for adolescents. The positive side is health care costs are shared between PHA and NGOs, a character constituting centralized health care system (Anderson, 2010). And having this partnership, the rural majority becomes major focus when delivering maternal health service with spirit of unity regardless of external complications. Under section 13(f) of PHAA gives opportunity for the government to shift their focus towards NGOs in terms of financial assistance to build a capacity for improving maternal health. In Chimbu, the church health service helps mothers in a village (keramug) by putting up a building for delivery after receiving sufficient from government. Therefore partnership between PHA and NGOs is the key to achieve KRA5.
(2) Single line of Reporting (communication) Channel
It is vital when it comes to reporting about number of deaths, births and pregnancies for each province, disease outbreaks, performance of health practitioners and funding needs, through the reporting system of the NDoH which gives real figures of the province. Under section 28(1) & 28(2) of PHAA, the boards of PHA make annual report to the Minister and Governor of the province. The report flows from point A (i.e. PHA) to point B (i.e. NDoH-Minister) through single channel of communication). Based on that reports the minister make assessment, and find out if there were misappropriations or corruptions involved , he appoint Commissioner of Inquiry comprised of three members to justify administration on the grounds where they went wrong. Having single reporting channel between two members is significant in avoiding reporting of false, misleading and duplicated information, from various reporting parties to NDoH. From 1949- 1976, there were only two governments-National and Community governments. The national government dealt directly with communities and funding was sent directly to the Community Government. Consequently service delivery in terms of infrastructure developments were at highest peak compared to current three system of government. The effect of service delivery is not effective, is reflective of having three levels of government compounded with several levels (stages) of reporting systems, so the quality of the information provided fades along different levels before it reaches National government. Likewise, having one health system dealing directly with NDoH-Minister is beneficial when addressing maternal health issues as well as health other issues, and remove idle functions one of dual health care system.
It is vital when it comes to reporting about number of deaths, births and pregnancies for each province, disease outbreaks, performance of health practitioners and funding needs, through the reporting system of the NDoH which gives real figures of the province. Under section 28(1) & 28(2) of PHAA, the boards of PHA make annual report to the Minister and Governor of the province. The report flows from point A (i.e. PHA) to point B (i.e. NDoH-Minister) through single channel of communication). Based on that reports the minister make assessment, and find out if there were misappropriations or corruptions involved , he appoint Commissioner of Inquiry comprised of three members to justify administration on the grounds where they went wrong. Having single reporting channel between two members is significant in avoiding reporting of false, misleading and duplicated information, from various reporting parties to NDoH. From 1949- 1976, there were only two governments-National and Community governments. The national government dealt directly with communities and funding was sent directly to the Community Government. Consequently service delivery in terms of infrastructure developments were at highest peak compared to current three system of government. The effect of service delivery is not effective, is reflective of having three levels of government compounded with several levels (stages) of reporting systems, so the quality of the information provided fades along different levels before it reaches National government. Likewise, having one health system dealing directly with NDoH-Minister is beneficial when addressing maternal health issues as well as health other issues, and remove idle functions one of dual health care system.
The centralized health system
provides the benefit of the doubt to people over long standing issues dealing
with Administration in terms of duplication of expenses and roles (Malabag, 2015). Through PHA the
Minister deals directly with the PHA, eradicate the problem of prolonging the
reports and cost of having several reporting stages. Under PHAA, the Minister finds if Administration
compromise any designated functions; the Ministers himself exercise his
executive power to sideline them in their position and perhaps appoint new
person. In the newspaper dated 15th June, 2016, the minister in his
letter suspended the CEO of the Western Highlands PHA over couple of
allegations against him after receiving the National Doctors Petition. And so when
we have one health care system linking one communication system is technically
possible for making current, effective and timely reporting on the issues
happening in PHA or from NDoH down to PHA.
By then necessary health resources will be mobilized and distributed
evenly among rural majority and urban disadvantages to improve maternal health.
France health
care system is centrally coordinated by the Ministry of Health and administered
by Actors in Hospitals, Clinics and other health care providers under centralized
health system, transferring of funds between patients and health care provides (WHO, 2010).
CONCLUSION
Through effective reporting, NDoH will be able asses operations of PHA and thus make rational decisions in relation to the NHP2011-2020. Reporting is the key for planning of resources acquiring and allocation, addressing existing and emerging health issues. Therefore under PHA, reporting is channeled between PHA and NDoH (Minister) is evident for achieving improved maternal Health. Through successful reporting system and partnership, France health department is able to coordinate and integrate with NGOs to provide a universal health care service (Chevreul, 2009). Partnership with NGO will help to solve maternal issues in the province and be able to resurrect some lost pride in health service delivery. As saying goes” two heads are better than one head”. And so it is time the Southern highlands Province should get PHA, to address health issues in the province.
References
Bertha Nhlema Simwaka, Sally Theobald,
Yaa Peprah Amekudzi and Rachel Tolhurst
BMJ: British Medical Journal
Vol. 331, No. 7519 (Oct. 1, 2005), pp.
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Linda,
W. (2010). Modern Health care system. Retrieved
May 16, 2016, from http://www.reuters.com/article/us-healthcare-modern-idUSTRE65K3F120100621
Chevreul, K. (2009). France Health care system. Retrieved May
19, 2016, from https://en.wikipedia.org/wiki/Health_care_in_France
Anderson, S. (2008). Centralized Health care system. Retrieved
May 10, 2016, from http://healthresearchfunding.org/6-pros-and-cons-of-centralized-health-care/
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