“The landscape is dominated by low-lying, hot, steamy jungle and crisscrossed by rivers and lagoons, which comprise the main mode of transport. It’s phenomenal how many people live in such an isolated and harsh environment, leading a subsistence existence and working so hard to survive.”
– Dr Denise Wild, volunteer
Western Province is the largest and most remote province in PNG. With few roads and travel by river and air made difficult by the high cost of fuel (about twice the cost of fuel in Australia), Western Province suffers major challenges to the delivery and accessibility of health services.
Over 200,000 people are sparsely spread over three districts – 97,000 square kilometres – comprising 21% of PNG’s total land mass.
Western Province borders Indonesia, as well as Australia (Boigu and Saibai islands in the Torres Strait). The provincial capital, Daru, is located on the island of Daru, in the south, and the largest town is Tabubil, site of the Ok Tedi mine, in the north.
North Fly has a vast jungle topography made up of high mountains and hills, floodplains and swamps, and plains. Average annual rainfall is 8,000mm in the Star Mountains, while altitude reaches up to 3,000m on the Hindenburg Range. The population density is about five people per square kilometre.
The district’s administrative centre, Kiunga, has a hospital, but presently no local doctor. People living in outlying communities such must travel four hours to reach Kiunga, others must travel for an entire day. There is a refugee settlement of 2,000-3,000 people at Iowara-East Awin.
There is one major road built and maintained by Ok Tedi Mining that links Tabubil to Ningerum and Kiunga. Otherwise, outboard motor boat and canoe travel are common along the Fly and Ok Tedi rivers.
Middle Fly covers the extensive plains, floodplains and hills of the Fly and Strickland rivers from Nomad in the north to the Fly River delta in the south. Many areasare subject to frequent flooding. In the Awaba River region many villages have huge populations, including 3,000 to 4,000 people in Makapa.
There is no doctor for 66,000 people in Middle Fly. Most people must travel for 4-8 hours to reach the nearest health service centre, staffed by community health workers. There are no major roads, and outboard motor boat and canoe travel are common along the Fly, Strickland, Aramia and Bamu rivers.
Source: Papua New Guinea Rural Development Handbook (2001)
“There is no health worker, village health volunteer or village birth attendant in this village. Women deliver here with the help of the other women as it is too hard to get to Iowarra.”
– Dr Josette Docherty, volunteer
There are major challenges to the delivery and accessibility of health services in the region. Mountainous topography, coupled with high rainfall, means patients and medical outreach staff face long and arduous journeys across inhospitable terrain by road, river or air to medical facilities.
Western Province has just 10 local doctors for a population of 200,000 people, yet in some of the more remote regions there are no doctors or nurses at all. This includes Middle Fly District, where there are no doctors for 74,800 people whatsoever.
Not surprisingly, statistics show that access to health services in the region has declined in recent years.
From 2003 to 2007 there was a 35% decline in the conduct of medical outreach clinics for children under 5, with the largest decrease in North Fly. In 2007, 56% fewer health centres were visited by a medical officer compared to 2006. (2)
Reduced access to health services has impacted on childhood immunisation rates, with a 4% drop in the number of children under one immunised for diphtheria, tetanus, and pertussis, from 55% in 2006 to 51% in 2007. The national immunisation rate is 68%. (2)
The province’s measles vaccination rate continues to remain under 50%, compared to the national average of 53%. (2)
The fertility rate, at 5.6 children per woman, is higher than the national average of 4.6. (1) About 28% of women in the province do not receive any antenatal care. This means no monitoring during pregnancy, no birth planning, and no treatment or prevention of malaria or neonatal tetanus*. However, the province fares better than the rest of the country, where on average 34% of women do not receive antenatal care. (2), (3)
*Neonatal tetanus occurs in non-sterile home deliveries, and is mostly fatal (source)
The province’s current infant mortality rate is 6.6% (66 deaths per 1,000 live births); a dramatic improvement on its 2000 rate of 8.3% but still higher than the national rate of 5.4%. (1)
The Western Province has mortality rate of 3.18% for children under five years of age due to pneumonia, which is above the national average of 2.87%. (3)
Diarrhoeal disease, serves as an indicator of water quality, food hygiene and personal hygiene. The Western province has had the highest incidence of diarrhoeal illness in children under 5 throughout all of PNG from 2009-2012. (3)
Over the period from 2003 to 2007 there were less severely malnourished children under five (those weighing less than 60% of the expected weight for their age). (2)
While under-nutrition, that is to say children under five weighing only 80% of the expected weight for their age, continues to decline in the province, high levels of childhood under-nutrition are still seen in the South Fly district. (2)
Birth weight is a reflection of the health of the mother during pregnancy and an important indicator of an infant’s health. The percentage of low birth weight babies has declined from 14% to 8% from 2008-2012. While there was an overall improvement in infant birth weights low birth weight is seen most frequently in the South Fly district. (2), (3)
The incidence of malaria in Western Province has been declining since 2008 from 330 cases per 1000 population in 2008 to 180 per 1000 population in 2012, however,Western Province has the fourth highest number of nationally reported cases of the deadliest strain of malaria, p.falciparum. (2), (3)
All but eradicated in most of PNG, leprosy remains a serious problem in Western Province, which has the country’s second highest incidence of the disease after West Sepik.
Lymphatic filariasis is endemic to PNG, which has the highest infection rate in the world. Nationally, about half the population are infected, while Western Province has an infection rate of up to 80%, rising to 98% in some areas.
HIV prevalence rates, at 1.05%, are significant in Western Province, whose numerous transport and migration routes and mining and logging sites make it a high-risk area for HIV infection. Other risk factors include access to urban centres, lack of awareness programs and testing facilities, and ongoing stigma and discrimination. (1)
Reflecting national trends, married women are the most likely group to be exposed to HIV/AIDS, and also the most difficult demographic to reach in order to raise awareness of the disease.