A Partnership Model for Improving Service Delivery in Remote Papua New Guinea: A Mixed Methods Evaluation

Abstract

Background: The Community Mine Continuation Agreement Middle (CMCA) and South Fly Health Program (the Health Program) is a partnership for improving health service delivery in remote Papua New Guinea (PNG). The Health Program is delivered by a private contractor working in partnership with existing health service providers to improve service delivery using existing government systems, where possible, and aligns with national policies, plans and strategies. A midline evaluation was conducted to determine changes in health service delivery since commencement of the Health Program. Methods: A mixed methods evaluation was undertaken mid-way through implementation of the Health Program, including a pre/post analysis of health service delivery indicators, semi-structured interviews with health workers and assessment of health facility equipment and infrastructure. Results: Improvements in many of the long-term expected outcomes of the Health Program were observed when compared to the pre-program period. The number of outpatient visits per person per year and number of outreach clinics per 1000 children under 5 years increased by 15% and 189% respectively (P<.001). Increases in vaccination coverage for infants aged <1 year were observed: 58 % for pentavalent 1st dose (P<.001) and 75% for 1st dose Sabin (P<.001), 30% for 3rd dose pentavalent (P<.001) and 26% for measles vaccination (P<.001). Family planning coverage remained at similar levels (increasing 5%, P=.095) and antenatal care coverage increased by 26% (P<.001). Supervised deliveries coverage declined by 32% (P<.001), a continuation of the pre-Program trend. The proportion of facilities with standard equipment items, transport and lighting increased. Health worker training, in particular obstetric training, was most commonly cited by health workers as leading to improved services. Conclusion: Following implementation, substantial improvements in health service delivery indicators were observed in the Health Program area as compared with pre-program period and the stagnating or declining national performance. This model could be considered for similar contexts where existing health service providers require external assistance to provide basic health services to the community

Improving the quality of maternal and newborn care in the Pacific region: A scoping review

“…PNG-specific may not be generalisable to the Pacific region. N/A Field [31] 2018a PNG Community Mine Continuation Agreement Middle and South Fly Health Program aimed at improving health service delivery in remote PNG. Program evaluation Mixed methods – pre/post analysis of health service delivery indicators, semi-structured interviews with health workers and assessment of health facility equipment and infrastructure.…”

“…Several studies centred around community development and health promotion initiatives, such as promoting contraceptive use and immunisation [28] , [29] , [30] . Other interventions aimed to improve infrastructure, resources and equipment, such as: building staff houses and community health posts, renovations to existing health facilities, and increasing availability of various essential medical supplies, equipment and oxygen provision [ 31 , 32 ]. Several service-specific interventions aimed to improve morbidity and mortality audit systems [ 30 , 33 – 36 ], management of perinatal deaths and bereavement care [ 35 , 37 ], and antimicrobial prescribing practices [38] .…”

“…Other interventions included a contraceptive implant outreach service [44] , prevention of parent to child HIV transmission programs [45] , development of maternal and newborn health action plans [31] , reviews of national clinical policies and standards [29] , midwifery leadership programs [46] and the formation of Public Private Partnerships at regional and national levels [ 31 , 47 ].…”

“…Other interventions included a contraceptive implant outreach service [44] , prevention of parent to child HIV transmission programs [45] , development of maternal and newborn health action plans [31] , reviews of national clinical policies and standards [29] , midwifery leadership programs [46] and the formation of Public Private Partnerships at regional and national levels [ 31 , 47 ]. Proportion of Australian and international participants who were knowledgeable and confident regarding management of perinatal deaths increased from pre-to post-workshop for all items and stations (p < 0.001).…”

Factors That Influence Data Use to Improve Health Service Delivery in Low- and Middle-Income Countries

“…1,4,6,68,69 The literature also contains many examples of qualitative data being used as part of mixed methods design for M&E activities. [70][71][72][73] The rationale for using qualitative data is to improve data validity, reliability, and credibility. 68,69…”