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Papua New Guinea – Annual symposium of the PNG Society of O&G

Dr Mary Bagita
The annual scientific symposium was held in Madang during 29-31 August. The President, Dr Mary Bagita delivered the opening address and highlighted the theme of the meeting to focus on adolescent health, “Adolescent Health – a growing challenge”.
It was pleasing to see large numbers of O&G Specialists, clinicians, health extension officers, nurses and midwives turn up to the meeting. The host team in Madang, Dr John Bolnga and his colleagues extended a warm welcome to the visitors and made special efforts to keep the discussions interesting and dynamic.  The Society also managed to hold its annual general meeting with its members to discuss its business.
At its opening session, a moment of silence was observed in remembrance of Dr John Maku who passed on during the course of the last 12 months. Dr Maku was an expert Paediatrician who dedicated his life in serving his people. The President provided an excellent opening speech which highlighted the achievements of the Society despite the many challenges in providing health care in PNG. She paid tribute to two women: Ms Carmel Walker of the Royal Aust and NZ College of Obstetricians and Gynaecologists and Dr Rufina Latu from WHO, both of whom have made significant support and contribution to the work of the PNG O&G Society and overall support in the Pacific region through the Pacific Society of Reproductive Health. Both ladies recently retired from their respective organisations in June 2018.
As was the practice in previous O&G annual symposium, Provincial SMOs made presentations on maternal and newborn statistics and described achievements and challenges. The keynote address was given by Mr Koffi Kouame, UNFPA Country Representative in PNG.  Other speakers included representatives from National Dept of Health, WHO, UNFPA, IPPF and Port Moresby General hospital. Mr Moses Sariki from the Madang Provincial Education Office spoke on the need for educating our young people on Adolescent Sexual and Reproductive Health Issues in PNG. Other relevant topics in line with the theme included: update on the HPV Vaccination, mental health and youth-friendly services. One of the main areas for discussion was prevention of adolescent pregnancy and supporting adolescents to use effective contraception. A panel group discussed how to manage minority groups that oppose contraception.
One of the highlights of the conference was the presentation of research projects by postgraduate students attending University of Papua New Guinea medical school.
The research topics included:

  • Reasons for not booking to ANC and comparing with the fetal and maternal outcomes for the booked mothers at Popondetta General Hospital – Dr Thomas Aiyak
  • Prevalence of Gestational Diabetes at Vunapope General Hospital – Dr Christine Tipayamb
  • Socio-demographic factors in IUD users at Kundiawa Hospital – Dr Megan Kona
  • A retrospective analysis of the Primary Indications of Caesarean Sections and the Maternal and Fetal Outcomes over 12 months at Kimbe General Hospital – Dr Samson Vava
  • Factors associated with initial Antenatal Care Visit at Buka General Hospital – Dr Oliver Ketauwo
  • Adolescent Pregnancy: A prospective study demonstrating the demographics and pregnancy outcomes in adolescents at Kavieng General Hospital – Dr Pauline Masta
  • Births before Arrival (BBA): Contributing Factors to BBA and Maternal and Fetal Outcomes at Modilon General Hospital – Dr Wendy Sapau

The 2018 symposium concluded with a panel to discuss “the Way Forward for Reproductive and Maternal Health in PNG, focusing on Adolescent Health”.  The panel was followed with a session to agree on the Resolutions of the meeting. The 2018 O&G Symposium identified the following Resolutions and proposed that the Society and its members take action in order to improve reproductive and maternal-newborn health, with special emphasis on adolescent health.

  • RESOLUTION 1:  Prevention of Adolescent Pregnancy
  • RESOLUTION 2:  Strengthen Adolescent Reproductive Health Services
  • RESOLUTION 3:  Strengthen Maternal Death Reviews to reduce maternal deaths

Scientific Meetings and Symposiums – Opportunities for Professional Development and Networking

by Prof Rajat Gyaneshwar
The modern day health professional aspires to be up to date in knowledge and skills to be able to provide the best care for their patients. The public expectation is that they will receive the highest level of care with compassion, respect and dignity. In response to these aspirations and expectations the Pacific Society for Reproductive Health (PSRH), national Obstetrics & Gynaecological (O&G) Societies of Papua New Guinea, Fiji and others have been increasingly involved in organizing biennial and annual scientific conferences, symposiums and workshops which bring together health professionals from the region to learn from each other and network. It is heartening that PSRH brings together different cadres involved in the delivery of Sexual and Reproductive Health (SRH) care, acknowledging that quality care requires a team effort to respond to the different aspects of SRH.
Professional development recognizes that all of us have the potential to continue to develop increasing levels of expertise as well as improvements in our approaches to deliver quality care.  It also recognizes that unless we are involved in maintaining our skill sets we tend to lose them. Thus an expert’s skills can be lost due to lack of practice. Additionally, it is important that health professionals keep abreast of evidence based best practices so that changes in management approaches are instituted appropriately. What was once best practice at some point in time may have become unacceptable practice.
It is important that we as individual practitioners become life-long learners and recognize that learning is our personal responsibility.  This requires regular reading, literature reviews, consultation and research. In addition, we need to search for opportunities to meet with our colleagues and learn through discussion, debating, sharing and listening. Scientific meetings and symposiums provide wonderful events for this. At these meetings we have the rare opportunity to interact with and listen to invited experts who can update us on evidence based practices.
The adult learning literature says that adults learn best by sharing and testing out their learning experiences with each other. The learning context must be respectful with plenty of opportunity to interact and to appreciate the exchange of experience. Our experience in the Pacific is that health professionals are most participatory and responsive to interactive learning opportunities. Conference and symposium organisers need to be cognizant of this and therefore capitalize on settings that use interactive participation.
From its early beginning in 1993, PSRH has worked to bring together health professionals so they can network and stimulate their learning through professional dialogue and sharing on a regular basis. Over the years, PSRH has linked up with RANZCOG, national O&G Societies, and national Midwifery Societies to broaden and expand the opportunities for adult learning in the field of maternal-newborn health and sexual and reproductive health. It is now 25 years since PSRH was established. Every 2 years it has held a well-structured scientific conference preceded by a number of technical workshops. The midwifery and O&G Societies have similar meetings at country level. Attendances at these meetings have generally been sponsored through donor contribution to PSRH, but sponsorships are becoming more difficult to negotiate. Therefore, it is logical that health professionals should start moving towards self-sponsored participation in these meetings.
Having worked in the Pacific for more than 40 years, I am humble to say that I am still learning from fellow professional colleagues. I wish to aspire you all to commit yourselves to doing the best for our patients by maintaining clinical competence and adhering to current best practices in all aspects of safe pregnancy and delivery and overall women’s health.  At every stage of the health profession, everyone should take responsibility for one’s own professional development and as we go up the ladder, we should adopt leadership skills and become role models for junior colleagues.


Recent WHO work and important documents by partners

Recent WHO work and important documents by partners in the area of Reproductive Health, Maternal-Newborn, Child and Adolescent Health (RMNCAH) and health through the life-course (April 2018)

Protecting, promoting, and supp
1.Protecting, promoting, and supporting breastfeeding in facilities providing maternity and newborn services: the revised Baby-friendly Hospital Initiative 2018 Implementation Guidance.

WHO and UNICEF issued new ten-step guidance to increase support for breastfeeding in health facilities that provide maternity and newborn services. The updated guidance is intended for all those who set policy for, or offer care to, pregnant women, families and infants: governments; national managers of maternal and child health programmes in general, and of breastfeeding- and Baby-friendly Hospital Initiative (BFHI)-related programmes in particular; and health-facility managers at different levels (facility directors, medical directors, chiefs of maternity and neonatal wards). The document presents the first revision of the Ten Steps since 1989. The topic of each step is unchanged, but wording has been updated in line with evidence-based guidelines and global health policy.
Related documents

2 .Standards for improving the quality of care for children and young adolescents in health facilities

On 24 April 2018, WHO launched Standards for improving quality of care for children and young adolescents in health facilities. These paediatric standards take into consideration a child’s right to health while recognizing that their health; physical, psychosocial, developmental and communication needs differ from those of adults.

3. Civil Registration and Vital Statistics (CRVS)

A well-functioning CRVS system registers all births and deaths, issues birth and death certificates, and compiles and disseminates vital statistics, including cause of death information. It may also record marriages and divorces. Despite the well-documented benefits of CRVS, many countries do not have adequate systems in place. The births of tens of millions of children are known to be unregistered every year, and it is estimated that two-thirds of deaths are never registered. WHO and UNICEF called for greater commitment to strengthen CRVS systems.

4. Factsheets

5. WHO publications/information


News from the Secretariat

PSRH wishes to announce its Biennial Conference scheduled for July 2019 to be held in Port Moresby, Papua New Guinea

  • Host Country: Papua New Guinea
  • Dates: July 6 – 11th July
  • Pre-conference workshops: 6-8th July (Medical School, University of PNG)
  • Conference: 9 – 11th July
  • Venue: Stanley Hotel, Port Moresby
  • Theme: Pacific Experience for Pacific Solutions in Reproductive Health”

Please check PSRH website for more information.


New appointments

 Professor Alec Ekeroma, the Hon CEO of PSRH, has from last September, become the Chair of the Department of Obstetrics and Gynaecology at the Wellington School of the University of Otago (UoO). The UoO position is an academic promotion for Alec and he will be the first Pacific academic to reach a professorial role in any area of medicine in either Australia or NZ. Alec feels privileged that his long academic service and leadership work in the Pacific is recognized and revels in the potential importance of the role “to lead the department of obstetrics and gynaecology in the nation’s capital, further my research collaborations in NZ and the Pacific and innovate in training future O&G leaders in NZ and the region”. The second appointment is a call to assist Samoa strengthen the new School of Medicine at the National University of Samoa. He will divide his time between Wellington and Samoa.  



In this issue of the newsletter, we congratulate three ladies on their retirements. They have dedicatedly volunteered and invested immense amount of time and effort in the development of PSRH, in the midst of their professional duties required by their respective employers in the area of women’s health in the Pacific region. Aliote, Carmel and Rufina have now retired as of end June 2018.  For many years, they worked with dedication, commitment and leadership in promoting reproductive health, maternal and newborn care in the region. PSRH and the Pacific families wish them well and a fulfilling retirement.

  • Matron Aliote Galuvakadua retired from Fiji Government as Matron of the CWM Hospital
  • Ms Carmel Walker, Senior Coordinator for the Global Health Unit, retired from the Royal Australian and NZ College of Obstetricians & Gynaecologists
  • Dr Rufina Latu retired from the World Health Organisation as Medical Officer for MCH, Papua New Guinea

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After providing 33 years of professional duties in nursing and midwifery, Matron Aliote retires from Fiji civil service. Aliote graduated from nursing in 1985, a profession she had committed her life to. In 1995 she completed her midwifery training, she worked in CWMH hospital and its Anderson maternity unit for these 33years and in July 2009, Aliote became the maternity unit Matron. Anderson maternity unit is the maternity unit of Fiji’s largest hospital, the Colonial War Memorial Hospital in Suva. In this position, she was a midwifery leader, a supervisor, a manager, and a mentor for midwives.

Matron Aliote had the honour to serve as 3rd President of the Fiji Midwifery Society. In this role, she dedicated 9 years of professional guidance and leadership to benefit other midwives in Fiji and the Pacific. In May this year at the occasion of the International Day of Midwives, she handed over the President’s role to the Society in anticipation of her retirement in early June.

Matron Aliote’s passion for midwifery extended to reach other Pacific countries through her involvement with the Pacific Society for Reproductive Health. She was elected into the PSRH Board in 2011 at the BGM held in Honiara, Solomon Islands. Aliote moved up to become the first Pacific midwife to hold the position of vice president (midwifery) for PSRH for six years.  

At her farewell she remarked, “I am assured that my co-workers will continue the work we have established together, setting midwifery standards in our main hospital. They have the knowledge and the skills and I trust that all will go well. It has been a fulfilling and rewarding experience to service my country as a midwife.”


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Carmel Walker Retires

Ms Carmel Walker is retiring from The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) in June 2018, after 32 years of service, most of those years providing support to the Pacific region through development of the human resources capacity of Pacific O&G specialists, midwives and reproductive health workers.  Carmel was an integral player in the establishment of our Society, originally named the South Pacific Regional Obstetrics and Gynaecology Society (SPROGS) in 1995 but renamed to PSRH in 1997.  She was the Executive Assistant until 1999 when the secretariat moved from Melbourne to Fiji and continued to take a senior role in arranging and sourcing funds to support the attendance of Pacific doctors and midwives at our PSRH Biennial Meeting since then.   Within RANZCOG, as Senior Coordinator of the Global Health Unit, Carmel was involved in the establishment of Associate Membership and the CPD Program for Pacific O&G Specialists which today boasts 60 Pacific Associate Members, and is the envy of colleagues in other specialties in the Pacific, and she has continued to manage and improve this area.  She has also managed the Brian Spurrett Fellowships since 2004 and the RANZCOG Pacific Midwifery Leadership Fellowship Program through Australia Awards, since 2010 until now – a total of 120 Fellowships for midwives.   In 2011, Carmel was awarded the inaugural PSRH President’s medal in acknowledgement of her contribution to training and development of reproductive health workforce.

“I am blessed that my position at the College has allowed me to make a real contribution to the Pacific reproductive health workforce.  Working with Pacific doctors, midwives and College colleagues has taught me resilience and patience, but it has also given me great joy in seeing the results of development opportunities for my Pacific colleagues.  I’ve learnt over the years that little changes can make a big difference, that empowering people to be their best will bring out the best in them, and that by working together we can achieve more than we ever can by ourselves.  

Observing the growth in the O&G workforce over the past thirty years has been inspiring, given an ever-changing environment with ongoing health, system and resource challenges, as well as natural disasters that can, and do, strike at any time.  However, our Pacific O&G and midwifery workforce is well connected and supportive of each other.  They are aware of their leadership responsibilities, and are committed to developing their own knowledge and skills, finding solutions to challenges and thinking of new ways to improve women’s health in their settings.

As well as our O&G workforce, I am inspired by and proud of our Pacific midwifery network, and in particular, those with whom I have worked through the RANZCOG Brian Spurrett Fellowships since 2004, and since 2010, the Pacific Midwifery Leadership Fellowship Program held in Sydney and Auckland.

Working with our team of program facilitators at the Nepean and Liverpool Hospitals, we have enabled many Pacific midwives to raise their status as seen through the eyes of their colleagues, and to make a higher level of contribution to their maternity and reproductive health care services.  Each group of midwives who come to Sydney for the midwifery leadership program excite me with their potential and enthusiasm for returning as motivators for change on their return home.

But for now it’s time for me to step back – chill out – and take a break to do some travelling around Australia.  My plans are to relocate to Queensland, not far from Cairns, where I can move onto new challenges and projects where I can help other people with their lives.

It has been an enormous pleasure and joy to work with my PSRH colleagues and my strong ties and love for the Pacific won’t be diminished, that’s for sure.  I will continue to keep in touch with so many friends and colleagues well into the future.   I wish you all the very best as you continue to provide quality care to families across the Pacific, and be the best you can be.”


Dr Rufina Latu Retires D:\Users\latur\AppData\Local\Microsoft\Windows\INetCache\Content.Word\IMG_20180222_093633.jpg

Dr Latu retires after working with WHO for nine years.

“What a rewarding feeling to have contributed to health and development in the Pacific during the past 37 years. It has been a fulfilling experience of delivering health services, managing health programs, providing peer support; and facilitating capacity building, networking, strategic engagement, leadership and professional growth.”  

Prior to retirement, Dr Latu was Team Leader for Maternal and Child Health programme with the World Health Organization based in Port Moresby in Papua New Guinea.  In this position, she worked with PNG government at national and provincial level, UN agencies, international and national NGOs, health training institutions, and professional bodies such as the O&G Society, Paediatric Society and Midwifery Society of PNG. She has wide Pacific experience and worked for more than 25 years in the Pacific countries in the areas of health systems strengthening, service delivery, public health, non-communicable disease, family planning, reproductive health, maternal-newborn, child and adolescent health, and primary health care. On longer-term technical advisory role, she has worked in PNG, Fiji, Vanuatu and Tonga, providing support to governments in the development of programmes and services.

Dr Latu has been a pioneer member of PSRH and contributed to its growth and development since its inception in 1995. She attended all PSRH biennial conferences except the Madang meeting (PNG) in 2001. The most recent one was in Port Vila, Vanuatu in 2017 where she was chair of the scientific committee and assisted the PSRH Secretariat in the preparation of the conference agenda. She also carried out a number of key voluntary contributions to the work of PSRH and included taking on the role of President, a member of the PSRH committee, and also volunteered to undertake the editorial functions for the PSRH newsletter over the last four years.


Papua New Guinea: Bachelors Program in Midwifery – rural attachment

Papua New Guinea:  Bachelors Program in Midwifery – rural attachment
Ms Paula Puawe, Midwifery Coordinator, University of Goroka
The University of Goroka offers a Bachelor of Midwifery program for nurses who have completed a three-year nursing diploma at a school of nursing affiliated with a university. Graduates of the 18 months degree course are awarded a Bachelor of Midwifery. The curriculum links theory and practice to the competency standards of the Nursing Council of PNG. Students must spend 16 weeks in labour ward, four weeks in antenatal clinic, three weeks in special care nursery, five weeks in the obstetrics and gynaecology ward, and eight weeks in a rural health setting.
At the end of the midwifery course, graduates may work in urban hospitals, rural hospitals or health centres in urban, rural in remote settings. Most of the clinical practice is taught in urban hospitals and clinics. In order to prepare students to work in rural environments, eight weeks of clinical practice is conducted in a rural setting. While this allows them to experience resource-scarce environments, they have more contact with the community.  A broader range of skills beyond clinical midwifery is needed in rural primary care setting.
The internship program helps trainee midwives develop community health skills to better respond to the needs of people. It was an opportunity to work in a community setting to understand traditional practices and beliefs about health and maternal and neonatal issues and how they manage at the community level. As most of the students return to work in rural and remote locations after graduation, rural placement is a crucial component of the program. It ensures that students are theoretically and practically prepared to work as midwives in any setting.
A total of 38 midwifery students were divided into five groups and each group was assigned an educator to a rural health centre in Eastern Highlands Province. The rural attachment was conducted for 8 weeks. Each group was to carry out a project in addition to the usual clinical practice in the rural health centre. The five project activities were postnatal home visits, clinical audit, community engagement, newborn care and rural staff capacity building and mentoring. Students gained additional skills especially in the areas of research, clinical audit, community engagement and postnatal home visit as this were all new innovative activities.
Rural health internship is part of the bachelor of midwifery program. The internship provides an opportunity for students to experience rural health practice and to be exposed to challenges and opportunities for improving maternal and newborn health. Both students and educators were positive of the program as it helped to build knowledge and skills in community health and provided rural experience in caring for women, newborns and families.  The project recommended that the internship program becomes a mandatory part of the midwifery course.


Samoa: New Health Specialist Centre opens in Samoa

The Health Specialist Centre (HSC) is an innovative social enterprise model which provides private health care. It is a medical centre and a hotel, owned by Aiono Dr Alec Ekeroma and was opened in May 2018.
The HSC has two consulting rooms that will carry out minor/local anaesthetic procedures, a waiting room and a pharmacy/laboratory. The computers in every clinical area links to electronic patient files stored securely in the cloud. The centre is working towards being a paperless operation with specialist entering all data electronically which will assist in discussions with specialists overseas. According to Aiono, the clinical services can be expanded into hotel rooms if there is a demand and a cost-benefit assessment justifies as such in the future. This development has been strategically planned so that as demand grows, expansion of specialist activity to other rooms can occur, as long as new services are justified. Since most specialists are working part time and after-hours, and the clinics structured and rostered, the two rooms currently allocated is sufficient space into the medium term. The specialist centre is in a prime location close to the Tupua Tamasese Meaole (TTM) Hospital and the medical and nursing schools.
The HSC specialists will be credentialed to perform within their scope of practice and will be required to sign a code of conduct that will cover knowledge of patient’s rights, a duty to clinical audit and clinical governance. The contractors will form their own group led by a clinical director and are mandated to develop, sign off and implement clinical protocols and processes such as health and safety, infection control, patient satisfaction. The clinical group will handle all matters of clinical governance.


Fiji: Midwifery Society celebrated 2018 International Midwifery Day

The Fiji Midwifery Society celebrated International Midwifery Day in a unique way – each health division developed its own event. This allowed the celebrations to take place in three locations at the same time – Central, Northern and Western. Labasa Hospital hosted the occasion in the Northern Division while Lautoka was host for the Western Division. The Central Division celebration was held at Makoi Maternity Unit in Suva.
The theme for the day celebration was “Midwives Leading the Way with Quality Care”, taken from that of the 2018 International Council of Midwives. Our very own Chief Nursing and Midwifery Officer (CNMO), Mrs Selina Waqa Ledua was the Guest of Honour for the day. In her address, she reminded midwives on the concept of Quality Midwifery Care from the clients’ and customers’ perspectives. Quality midwifery care translates to a smiling midwife with compassionate and care when delivering her duties. Student midwives also participated at the occasion and spoke on theme of midwifery-led model. This model will be applied at the new Makoi maternity unit – to showcase innovations in midwifery-led care.
This midwifery event also promoted NCD messages of eating healthy foods, so instead of having a celebration cake, a huge fruit platter was shared. The Hospital Chaplain Rev. Jone Marika conducted the devotion and highlighted the importance of midwives and their biblical roles.
To honour the event, other groups were invited including families of midwives, NGO’s representatives and retired midwives.  The day’s program included a walk through the new Makoi Maternity Unit. This unit will start birthing services by end of June. The CNMO had open talks with midwives to ensure that Makoi Maternity Unit provides quality midwifery care.  Matron Aliote Galuvakadua is the current President of the Fiji Midwifery Society.


Maternal deaths in PNG – a national health crisis

Maternal deaths in PNG – a national health crisis
ChildFund Australia reports
ChildFund Australia is an independent and non-religious international development organisation that works to reduce poverty for children in developing communities. The deeper analysis into maternal deaths in PNG by ChildFund has led to the publication of a report titled “A national health crisis: maternal deaths in Papua New Guinea”. The report, published in May 2018, highlighted the high rates of maternal and infant deaths, documented as worsening, particularly in rural areas.
Large proportions of women do not have access to antenatal care and safe delivery. The coverage rates have been low for decades. In some clinics, the number of women attending a proper clinic where there’s trained support, the numbers have reduced in the last five years. The number antenatal care has declined and the situation seem to be worsening, quite the opposite to most of the other countries in the region.
In past years, the government and development partners jointly support MCH interventions including early newborn care, antenatal and postnatal care, childbirth, family planning and maternal death surveillance and response (MDSR) systems. However, implementation has been slow and weak. The challenges of delivering effective MCH interventions are due to a combination of health systems issues and community factors which hinder progress for intended improvements. Poor access to essential health care is fuelled by lack of skilled human resources, poorly maintained and equipped health facilities, lack of basic medicines, poorly managed financial flows, geographical distance between communities and health facilities, and weak leadership and management. In addition, inadequate community knowledge and motivation, and poor health-seeking behaviour contribute to under-utilisation of reproductive health and MCH services. As a result, maternal-newborn services remain sub-optimal in most provinces.
The ChildFund report indicates there is an urgent need for more midwives and better health facilities, particularly in the rural villages and districts where most women are giving birth. Many women end up giving birth at home. Many rural health facilities are often only staffed by volunteers.
The high maternal mortality rate is mainly due to poor access to health care for the large numbers of rural women. This makes common complications such as postpartum bleeding, infection and prolonged and obstructed labour difficult to manage.
Specialist Obstetrician, Dr Mary Bagita, says gaining access to maternity care is tough for rural women where the road conditions are poor, air transport is scarce and facilities like water supply may not exist at their local health centre. She is based in Port Moresby where the hospital also receives referrals from surrounding provinces. Often by the time women reach the hospital, she often is unable to save them.
Access is an important constraint. When women are referred from rural health centres to hospitals for management of life-threatening conditions, they are often too sick to recover and eventually die.  Complex societal issues contribute to poor pregnancy outcomes. In a culture where male dominance is predominant,  poorly educated women can’t speak up for herself. She doesn’t have much control over what she can do. So that adds to problems of pregnant women. Domestic violence has a very negative impact for both mothers and babies as women don’t seek help and feel like there is nowhere for them to go.
Many development partners are in agreement that the challenges can be overcome with sustained effort and sizeable investment at scale. There are many excellent front line health workers who are committed to making a difference in the lives of women and newborn babies. They need so much more support.
The report indicates that while the national policy and strategies are in place, they need better planning, resourcing and co-ordination to deliver health services to the whole country.
To access online copy of the full report, please contact:
ChildFund Papua New Guinea, PO Box 671, Gordons NCD; Tel (675) 3232544; email: