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: email@example.com
Maternal deaths in PNG – a national health crisis
Urogynaecology is part of gynaecology that is involved in the assessment and treatment of women with pelvic organ prolapse, urinary and faecal incontinence. It is a common problem but often hidden because of embarrassment and shame and a lack of awareness that there is anything that can be done to help. NZ MFAT has supported a project scoping the extent of the problem in Fiji and doing a needs assessment on how to upskill health professionals in this field. It is a multidisciplinary approach with upskilling of nurses, midwives, primary care doctors as well as O&G specialists.
I recently spent a week at Port Vila in Vanuatu with Drs Harry, Tungu and Damutalau assisting in prolapse surgery and teaching the midwives and student midwives about perineal suturing. I was very impressed with their surgical skills and enthusiasm and look forward to working with them again in the future to expand their services in quantity and quality.
If you are interested please contact meat Jackiesmalldridge@gmail.com
My colleague, Dr Louise Tomlinson, myself and others have been developing a program that we hope to launch at the next PSRH meeting in July 2019. This is in response to a need identified by Pacific midwives particularly from remote areas where referral can be difficult if perineal trauma is severe. We want to extend the scope of the perineal suturing workshops that we usually run at the PSRH meetings and across the Pacific at other opportunities. As well as improving knowledge and practical skills, we wish to provide some tools to help the participant going forward. We have developed a laminated flip chart with step by step information about how to identify and repair perineal trauma that can be practically useful on a day to day basis. We hope to provide a set of instruments and appropriate sutures to use. We are working on how best to evaluate this program as it unfolds and have engaged some partners to support us financially.
We also want to identify “champions” in each country who are interested in perineal suturing and can act as mentors and troubleshoot for the participants in their countries. We also want them to help us collect data on how the program is going and how they can become trainers in the future.
If you are interested please contact meat Jackiesmalldridge@gmail.com
Papua New Guinea Midwifery Society is a registered professional body established in 2005. The Society’s main function is to support the professional development of its members in terms of regulation, education and association to promote maternal-newborn services. The society has been a member of the International Confederation of Midwives (ICM) since 2011.
The philosophy lies in the Society’s commitment to support national goals to develop adequate competent midwives to be deployed in all 89 health districts of PNG. The Society is committed to enhancing the skills and passion among midwives to provide comprehensive quality services for women and newborns, and promoting access to a safe supervised delivery. Sister Jennifer Pyakalyia is the President of the Society and has worked tirelessly to keep her members motivated and enthusiastic about midwifery issues.
During the 2018 International Day of Midwives, the PNG Midwifery Society held a national symposium to celebrate the occasion. More than 200 midwives came from provinces to share the universal theme of “Midwives leading the way quality care” through presentations, discussions and networking. The symposium was officially addressed by the Minister of Health, Hon, Sir Puke Temu whose words of encouragement uplifted the morale of the midwives.
Led by Prof Peter Stone, a one-week training workshop was conducted at the Honiara Referral Hospital for local doctors.
Preparations included pre-trip communication and planning, with national counterpart Dr Leanne Panisi identifying training needs and participants. Prof Stone adapted the workshop structure and schedule to suit local situation.
The training included both basic and advanced sessions in line with the experience of health professionals in O&G ultrasound scanning. Participants were very enthusiastic and there was evidence of immediate use of newly gained knowledge and skills. Working in resource scarce settings, it was not surprising that the main challenges with upskilling ultrasound skills revolved around outdated ultrasound equipment and unavailability of tissue diagnoses for abdominal masses identified on ultrasound scans. Procurement of such equipment is something the local team could discuss with the government. A follow up course with a focus on clinical problem-solving ultrasound is being recommended by the visiting team
Saving Mothers and Newborns – a collaboration between MFAT, Kiribati Ministry of Health and Medical Services, Pacific Society of Reproductive Health and Counties Manukau
In the Pacific Region, 3 women die from childbirth related causes and 30 new-born babies don’t survive following birth, EVERY DAY. Preventing the death of mothers and newborns is a key health priority for Kiribati. NZ MFAT has been supporting staff training for Kiribati Health workers to help address this problem, via the Pacific Emergency Maternal and Neonatal Training Course (PEMNeT). This is a practical hands on course where midwives, obstetric nurses and doctors train together to manage obstetric and neonatal emergencies well. The PEMNeT course was developed by the Pacific Society of Reproductive Health for use throughout the Pacific.
NZ MFAT funded a Pacific midwife/nurse and a doctor from many PICs to attend the inaugural PEMNeT Facilitator Training Workshop in July 2016 in Auckland. Since then MFAT (via the Counties Manukau Health, Pacific Health Development Unit, and Health Specialists NZ Ltd) has funded Dr Sharron Bolitho, Obstetrician at Christchurch Women’s Hospital to facilitate the implementation of this programme in Kiribati.
A PEMNeT Facilitators Training workshop was conducted from 16-18 April 2018, and immediately following this as part of their training, the Kiribati PEMNeT Facilitator team conducted a 2-day PEMNET course for health staff from Tungaru Central Hospital, Betio Hospital, and the health clinics. The facilitator team includes both doctors and midwives and the School of Nursing & Health (SoNH of Kiribati Institute of Technology) staff. The aim was to strengthen and build the local team, which was achieved.
The local team had many innovative ideas on how to increase the impact and effectiveness of the programme including;
- Adapting and localising the course further to make it really appropriate for Kiribati.
- Rolling out the training to the health centres/clinics based medical assistants, and nurse/ midwives, at the outer islands
- Designing and supplying an emergency box to every health centre/clinic in Kiribati for use in 2 of the birth emergencies which are the biggest killers of mothers worldwide. These are post-partum (post birth) haemorrhage and preeclampsia/ eclampsia (severe hypertension and seizures). Some Kiribati mothers have died from these causes within the last 10 years.
Much has been achieved with rolling out PEMNeT but there is still a lot of work to be done. This work is part of a wider Kiribati health strategy to build health workforce capacity. This project is a collaboration between MFAT (NZ), Kiribati Ministry of Health and Medical Services, Pacific Society of Reproductive Health and Counties Manukau District Health Board. This worthwhile work will benefit not only the mothers and babies of Kiribati, but the experience in Kiribati will be able to assist other PICs in making this an effective programme throughout the Pacific. Kiribati could be the leaders in the Pacific Region in PEMNeT!
Our PSRH team was in Samoa as part of the Cervical Cancer Prevention Programme in the Pacific. This was a multiagency workshop which gave opportunities for many leading clinicians from the Pacific to share the work in their own countries for cervical cancer prevention and screening. The two key recommendations out of the workshop include:
- The continued need for research; and
- The need for a regional policy for cervical cancer screening, treatment and vaccination.
Over the two days we heard about programme strengths and challenges that are in place in Fiji, Vanuatu, New Zealand, Malaysia, PNG and other initiatives that are in progress in Samoa and Tonga. We had delegates from UNFPA, WHO, Fiji and Samoa Cancer Society, many respected academics from New Zealand, Australia, USA and the Pacific. We also had ministerial presence from the Government of Samoa and the New Zealand High Commission Team.
Members of the past and present PSRH leadership contributed including Pushpa Nusair, Salausa John Ah Ching, Paula Puawe, Alec Ekeroma, James Fong and Ireen Manuel. PSRH is proud to be in this pathway with our member countries and we will stay committed to developing a regional policy on cervical cancer prevention.
Media Release: Samoa Observer: http://sobserver.ws/en/30_05_2018/local/33586/Tackling-cervical-cancer-in-the-Pacific-region.htm and Radio NZ: https://www.radionz.co.nz/international/programmes/datelinepacific/audio/2018647539/hopes-for-a-cervical-screening-programme-in-samoa
Glen DL Mola,1 Pamela J Toliman,2 and Andrew J Vallely2,3
1School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.
2Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
3Kirby Institute, University of New South Wales (UNSW) Sydney, Australia
Cancer of the uterine cervix is one of the most common cancers to affect women globally. Estimates from the Global Burden of Cancer Collaboration Group reported that in 2013, there were 485,000 cases worldwide and 236,000 deaths resulting from cervical cancer.1-3 Low- and middle-income countries experience 85% of the global burden of cervical cancer. In Papua New Guinea (PNG) and other countries in the Pacific region, cervical cancer is the most common cancer among women4; in PNG alone, an estimated 1000-1500 women die every year from the disease.5
Cervical cancer is caused by a sexually transmitted infection with certain oncogenic types of human papillomavirus (HPV). When most people get an HPV infection they mount an immune response and eradicate the infection from their bodies within a few months. In some people however, the HPV infection is not cleared in this way and the infection persists.6 The precise reasons for this are unclear, but persistence appears more likely following infection with certain HPV types, among women who smoke, and among those living with HIV infection.7 Women who experience persistent infection with one or more oncogenic HPV type are at increased risk of developing cervical pre-cancer and cancer, typically many years or decades after they were first infected.7
The epidemiology of cervical cancer would suggest that it should be relatively straightforward to prevent infection and to screen for the disease. Nothing could be further from the truth. Over the past several decades Pacific countries have followed various strategies to try and reduce the burden of cervical cancer, and yet the disease remains the commonest women’s cancer in most settings.
The development of safe, highly-effective HPV vaccines has revolutionised primary prevention for cervical cancer and brought the elimination of cervical cancer as a public health priority within our reach.8 The benefits of protective vaccination have so far however been largely conferred in high-income settings: much more needs to be done to accelerate the introduction and roll-out of HPV vaccine in Papua New Guinea and other high-burden countries in the Pacific.9
Secondary prevention (or screening) is a more difficult issue. The first screening strategy developed was based on microscopic examination of a cells collected from the cervix and either smeared onto a glass slide (the Pap test) or suspended in a liquid preservative (liquid-based cytology). Specimen collection can only be carried out by a health worker and requires a vaginal speculum examination, which many women find uncomfortable and/or embarrassing. Following collection, specimens are sent away to a specialist laboratory for cytological examination and the results communicated back to the health worker at a later date. Women found to have high-grade lesions on cytology (or ‘cervical pre-cancer’) are then asked to return for colposcopy and biopsy, a procedure requiring considerable gynaecological expertise. Biopsy specimens are sent to a specialist laboratory for histological examination, the results of which then enable health staff to decide the best treatment plan for each woman. Screening programs using such multi-step strategies have been the basis of cervical cancer prevention programs in high-income countries for decades and contributed to the steady decline in deaths due to cervical cancer in these settings.10-12 However, the resource requirements of such programs are high and include the need for highly-trained clinical and laboratory personnel and substantial laboratory capacity. Additionally, the follow-up of women with positive cytology by colposcopy and biopsy requires considerable coordination and resources.
For these reasons, establishing and sustaining cytology-based screening programs in low-income settings has been extremely difficult.13,14 For example, in Papua New Guinea, a cervical screening initiative was established in 1999 by a non-governmental charity (the MeriPath program), and provided a service from more than 30 health facilities in 16 provinces.15 The program was able to achieve only modest coverage however, with around 45,000 women screened over ten years (2001-2011), representing less than 4% of the target population aged 20-59 years. Also, as specimens were sent to Australia for testing, more than half of those found to have high-grade disease were lost to follow-up and therefore did not receive treatment, due to the delay between testing and recall. As such it was concluded that this Pap test screening strategy was not an effective one for the prevention of cervical cancer in this setting.5
Similar experiences globally prompted the World Health Organization (WHO) to recommend alternative approaches to screening in low- and middle-income countries, and in particular, to advocate ‘screen and treat’ strategies based on same-day testing or clinical examination followed by ‘freezing treatment’ of the cervix (cryotherapy) for women who test positive.16 A WHO-endorsed ‘screen and treat’ approach that has been used extensively in low-income settings around the world is visual inspection of the cervix with acetic-acid (VIA) or Lugol’s iodine (VILI). This strategy involves the application of acetic acid or Lugol’s iodine to the cervix and observing aceto-white staining (VIA) or areas where iodine has not been taken up (VILI), that are said to indicate underlying tissue abnormality. Favourable performance characteristics for the detection of histologically-diagnosed cervical ‘pre-cancer’ (cervical intraepithelial neoplasia (CIN) grade 2 or worse) in research settings17 has led to VIA being advocated as an accurate, low-cost screening strategy, and to its implementation in several low-income settings including Bangladesh, Tanzania and Thailand.18-20 Many countries have however experienced difficulties scaling up VIA while maintaining adequate quality, and have reported much lower sensitivity for the detection of cervical pre-cancer compared to research settings.17-22
In PNG, many of us held out high hopes that this approach would be more successful compared to the earlier Pap test program because it should not be necessary to locate the woman again, as the whole process could be concluded on one day. Pilot testing of VIA in two provincial sites has been disappointing for a number of reasons. First of all the finding that VIA positivity is not associated with HPV infection,23 or with underlying cervical pre-cancer.24 We have also found cervical cryotherapy cumbersome and time-consuming to administer in the clinic; and logistically challenging to sustain due to the need for a continuous supply of carbon dioxide (in our setting, obtained in cylinders transported considerable distances by road from the supplier).
In the last decade, the effectiveness of HPV testing for the detection of cervical pre-cancer and cancer has been demonstrated in large-scale studies,25,26 leading to the introduction of HPV testing for primary cervical screening in many high-income countries. The WHO recently recommended that HPV testing also be integrated into cervical screening programs in low-income settings, and that countries evaluate how best such testing strategies might be introduced and scaled-up.16 In PNG, we are currently evaluating a ‘test and treat’ strategy based on point-of-care HPV testing (using the GeneXpert HPV Test: http://www.cepheid.com/en/cepheid-solutions/clinical-ivd-tests/sexual-health/xpert-hpv) plus same-day treatment using a battery-powered heat probe (the WISAP C3 thermo-coagulator: https://www.thermo-coagulation.com/c3-mobile-coagulator/). The thermo-coagulator is optimised for low-resource settings and can be operated off a standard mains electricity power or via a small battery pack (invaluable for outreach screening activities). Other features of the WISAP C3 thermo-coagulator include a built-in LED examination light, a retractable heat protection safety guard, and a simple easy-to-use handling mechanism for accurate and safe treatment.
We have found that HPV test results using self-collected vaginal specimens (i.e. those collected by women themselves) are as good as test results using clinician-collected cervical specimens.27 We have also found that testing self-collected specimens for HPV infection can be used to identify women with underlying cervical pre-cancer:28 around 92% of women with high-grade disease can be detected and treated if screened by HPV testing alone, compared with less than 50% when screening is based on VIA examination alone (Table 1). This means that HPV testing alone is far more sensitive for detecting women with cervical pre-cancer than VIA examination alone. Only 8% of all women with disease were ‘missed’ (i.e. were not offered treatment) when HPV testing alone was used for screening, compared with 53% of women being missed when VIA examination alone was used to screen. Furthermore, using HPV testing alone to screen resulted in less women being over-treated (13%) compared to VIA examination alone (17%).
Using self-collected specimens means that only those who test HPV positive (around 10-15% of all those screened) require a pelvic examination. This means that experienced clinical staff can focus their time on providing counselling and treatment for those most at risk of disease. The use of a highly-portable, easy-to-use, battery-powered treatment device that requires 40 – 60 seconds treatment time per patient compared to around 10 minutes treatment time per patient with cryotherapy, has greatly reduced logistical and operational constraints in the clinic, and is also proving highly-acceptable to women. We are now working with colleagues in other Asia-Pacific countries to evaluate our point-of-care ‘test and treat’ approach in other high-burden settings in our region.
We recommend that health policy makers and political decision makers in the Pacific take note of these findings and allocate sufficient funds for HPV vaccination programs to prevent cervical cancer in the next generation, and for HPV testing and pre-cancer treatment in this generation, so that the scourge of cervical cancer can be reduced and eventually eliminated from our communities.
Table 1: HPV testing compared with VIA examination for the detection and treatment of underlying high-grade disease (cervical pre-cancer)
|Women with high-grade disease who were treated appropriately||Women with high-grade disease who were not treated (‘missed’)||Women without disease who were treated
|HPV testing alone||92% (33/36)||8% (3/36)||13% (64/491)|
|VIA examination alone||47% (17/36)||53% (19/36)||17% (80/491)|
- Fitzmaurice C, Dicker D, Pain A, et al. The Global Burden of Cancer 2013. JAMA Oncol 2015; 1(4): 505-27.
- LaVigne AW, Triedman SA, Randall TC, Trimble EL, Viswanathan AN. Cervical cancer in low and middle income countries: Addressing barriers to radiotherapy delivery. Gynecologic Oncology Reports 2017; 22: 16-20.
- Forman D, de Martel C, Lacey CJ, et al. Global burden of human papillomavirus and related diseases. Vaccine 2012; 30 Suppl 5: F12-23.
- Garland SM, Brotherton JM, Skinner SR, et al. Human papillomavirus and cervical cancer in Australasia and Oceania: risk-factors, epidemiology and prevention. Vaccine 2008; 26 Suppl 12: M80-8.
- Vallely A, Mola GD, Kaldor JM. Achieving control of cervical cancer in Papua New Guinea: what are the research and program priorities? P N G Med J 2011; 54(3-4): 83-90.
- Munoz N, Hernandez-Suarez G, Mendez F, et al. Persistence of HPV infection and risk of high-grade cervical intraepithelial neoplasia in a cohort of Colombian women. British journal of cancer 2009; 100(7): 1184-90.
- de Sanjose S, Brotons M, Pavon MA. The natural history of human papillomavirus infection. Best practice & research Clinical obstetrics & gynaecology 2018; 47: 2-13.
- Aranda S, Berkley S, Cowal S, et al. Ending cervical cancer: A call to action. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2017; 138 Suppl 1: 4-6.
- Tsu VD, Ginsburg O. The investment case for cervical cancer elimination. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2017; 138 Suppl 1: 69-73.
- Nanda K, McCrory DC, Myers ER, et al. Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review. Annals of internal medicine 2000; 132(10): 810-9.
- Qiao YL, Jeronimo J, Zhao FH, et al. Lower cost strategies for triage of human papillomavirus DNA-positive women. International journal of cancer 2014; 134(12): 2891-901.
- Landy R, Pesola F, Castañón A, Sasieni P. Impact of cervical screening on cervical cancer mortality: estimation using stage-specific results from a nested case–control study. British Journal of Cancer 2016; 115(9): 1140-6.
- Catarino R, Petignat P, Dongui G, Vassilakos P. Cervical cancer screening in developing countries at a crossroad: Emerging technologies and policy choices. World journal of clinical oncology 2015; 6(6): 281-90.
- Holme F, Kapambwe S, Nessa A, Basu P, Murillo R, Jeronimo J. Scaling up proven innovative cervical cancer screening strategies: Challenges and opportunities in implementation at the population level in low- and lower-middle-income countries. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2017; 138 Suppl 1: 63-8.
- Goyen J. Cervical screening in Papua New Guinea: 10 years experience of the MeriPath program. 47th Annual Symposium of the Medical Society of Papua New Guinea. Kimbe, West New Britain; 2011.
- World Health Organization. WHO Guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. Geneva: World Health Organization Press; 2013.
- Sauvaget C, Fayette JM, Muwonge R, Wesley R, Sankaranarayanan R. Accuracy of visual inspection with acetic acid for cervical cancer screening. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2011; 113(1): 14-24.
- Basu P, Nessa A, Majid M, Rahman JN, Ahmed T. Evaluation of the National Cervical Cancer Screening Programme of Bangladesh and the formulation of quality assurance guidelines. J Fam Plann Reprod Health Care 2010; 36(3): 131-4.
- Ngoma T, Muwonge R, Mwaiselage J, Kawegere J, Bukori P, Sankaranarayanan R. Evaluation of cervical visual inspection screening in Dar es Salaam, Tanzania. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2010; 109(2): 100-4.
- Chumworathayi B, Blumenthal PD, Limpaphayom KK, Kamsa-Ard S, Wongsena M, Supaatakorn P. Effect of single-visit VIA and cryotherapy cervical cancer prevention program in Roi Et, Thailand: a preliminary report. The journal of obstetrics and gynaecology research 2010; 36(1): 79-85.
- Basu P, Mittal S, Banerjee D, et al. Diagnostic accuracy of VIA and HPV detection as primary and sequential screening tests in a cervical cancer screening demonstration project in India. International journal of cancer 2015; 137(4): 859-67.
- Fokom-Domgue J, Combescure C, Fokom-Defo V, et al. Performance of alternative strategies for primary cervical cancer screening in sub-Saharan Africa: systematic review and meta-analysis of diagnostic test accuracy studies. BMJ (Clinical research ed) 2015; 351: h3084.
- Vallely AJ, Toliman PJ, Ryan C, et al. Association between visual inspection of the cervix with acetic acid examination and high-risk human papillomavirus infection, Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis in Papua New Guinea. The Australian & N Z journal of obstetrics & gynaecology 2018.
- Toliman P, Kaldor J, Badman SG, et al. Point-of-care Xpert HPV Test outperforms visual inspection with acetic acid, and a combination HPV/VIA algorithm, for the detection of high-grade cervical disease in Papua New Guinea. Australiasian Tropical Health Conference. Cairns, Australia: Australiasian Institute of Tropical Health and Medicine; 2017.
- Dillner J, Rebolj M, Birembaut P, et al. Long term predictive values of cytology and human papillomavirus testing in cervical cancer screening: joint European cohort study. BMJ (Clinical research ed) 2008; 337: a1754.
- Patanwala IY, Bauer HM, Miyamoto J, Park IU, Huchko MJ, Smith-McCune KK. A systematic review of randomized trials assessing human papillomavirus testing in cervical cancer screening. American journal of obstetrics and gynecology 2013; 208(5): 343-53.
- Toliman P, Badman SG, Gabuzzi J, et al. Field Evaluation of Xpert HPV Point-of-Care Test for Detection of Human Papillomavirus Infection by Use of Self-Collected Vaginal and Clinician-Collected Cervical Specimens. Journal of clinical microbiology 2016; 54(7): 1734-7.
- Toliman P, Kaldor J, Badman S, et al. Evaluation of self-collected vaginal specimens for the detection of high-risk HPV infection and the prediction of high-grade cervical intraepithelial lesions in a high-burden, low-resource setting. Clin Micrbiol Infect 2018: In press.
When women and girls are able to stay in school longer, access health services and empowered to plan for responsible motherhood, they can improve their social and economic opportunities, and ultimately transform their futures.
Although 70% of the health workforce is made up of women, this is often not reflected in leadership roles. It is important that more women join the ranks of health leadership where decisions are made about the health of women and girls
On the occasion of International Women’s Day on 8th March we reflect on the universal theme of “press for progress” through actions to advocate for gender equality and women’s empowerment. This annual event is a global day celebrating the social, economic, cultural and political achievements of women. The day also marks a call to action for accelerating gender equality and acts as a catalyst for facilitating change for progress.
For health professionals, the theme is focused around women in health leadership. As health advocates, we try to make this theme meaningful and valuable so that it inspires us in our everyday work. For many, the theme maybe just one of those catch-phrases for global attention to support a global health agenda. On a positive side, we can usefully apply the theme for our own purpose and advantage. If organisations, groups or individuals analyse the theme and unfold its meaning, we can gain better understanding of what it means for different settings, and how we may be able to advocate for women leaders in the health sector.
In some parts of the Pacific region, women are indeed already taking up positions of health leadership in many fronts and at all levels. Statistics indicate that at least 70% of the health workforce comprises women at various levels of professional responsibilities. A fairly large proportion of them are assigned to mid-level management, while the larger proportion are frontliners for service delivery working as clinical doctors, nurses, midwives and paramedics at all levels of health care.
Pacific women have reached leadership roles as health ministers, executive directors, clinical managers, consultants, heads of sections, health facility managers, supervisors and so forth. While we are making progress in senior leadership, it is important that we recognise that any health professional is a leader in his/her area of work, regardless of hierarchy. But often times, the role of leadership is not strongly embedded in job descriptions and remains a weak component of the recruitment and orientation process. As such, our current workforce systems often fall short in bringing about the essence of leadership functions, appropriate and relevant for different positions.
How do we address this shortfall? Often times the leadership roles are not well articulated in job descriptions; a missed opportunity. Therefore, we need to recognise its importance, provide an enabling environment to allow women to exercise leadership roles, and empower them so they can develop, expand their horizons and ultimately maximise their contribution to health outcomes.
Advocating for women in health leadership can impact on the way we work and the approaches we take for bringing about maximum health outcomes. The theme portrays the critical role of women as catalysts for change in health sector development.
“Women in health leadership” reminds us that as health professionals, we can influence health outcomes by supporting, advocating and investing in women to become stronger leaders in the health sector. There is ample evidence that investing in women is the most effective way to lift communities, organisations, and even countries to better socio-economic gains. Women’s participation makes strategic directions for health care stronger, societies more resilient and economies more vigorous. Women’s empowerment and leadership is critical to ensuring success across all 17 Sustainable Development Goals.
Empower nurses to improve global health: lifting the profile of Nurses and Midwives
Nursing Now is a three-year global nursing campaign run in collaboration with the International Council of Nurses and the World Health Organization. It aims to improve health globally by raising the profile and status of nursing, worldwide – influencing policy makers and supporting nurses to lead and build a global movement. Nursing Now was launched on 28th Feb 2018 by HRH the Duchess of Cambridge with nurses and health leaders across the world. The Pacific was represented by Ms Elizabeth Iro who recently joined WHO headquarters as Chief Nursing Officer.
Nursing Now is based on the findings of the “Triple Impact” report. The report concluded that as well as improving health globally, empowering nurses would contribute to improved gender equality – as the vast majority of nurses are still women – and build stronger economies. The campaign focuses on five strategic areas:
Ensuring that nurses and midwives have a more prominent voice in health policy-making;
Encouraging greater investment in the nursing workforce;
Recruiting more nurses into leadership positions;
Conducting research that helps determine where nurses can have the greatest impact; and
Sharing best nursing practices.
Nurses are at the heart of most health teams, playing a crucial role in health promotion, disease prevention and treatment. As the health professionals who are closest to the community they have a particular role in developing new models of community based care, community engagement and support local efforts to promote health and prevent disease.
The Nursing Now global campaign wants to make sure that all nurses and midwives across the globe, in every role at every level, are skilled and supported to develop and strengthen nursing and midwifery practice, mobilise others and really make change happen. The campaign can be adapted to suit the Pacific environment – an opportunity to raise the profile of Pacific nurses.
For more information, please download background paper