About Western Province – the area and health factors facing ADI volunteer Doctors

Western Province PNG where ADI volunteer doctors are helping with health issues

Western Province Is the Largest and Most Remote Province in PNG

“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. Throughout Western Province there are only 5 doctors, and the health worker to population ratio is 0.6 per 1000.

Over 228,000 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 District

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 is approximately 71,218.

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 District

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 areas are 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 almost 90,000 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)

 South Fly District

South Fly District shares its borders with Indonesia in the West and Australia to the South. Like most of Western Province, transportation between villages is difficult unless by air or boat. South Fly is prone to floods and lengthy dry seasons.

There is a population of approximately 67,000 in South Fly District, many of which are avid fisherman, which is a major source of income in the provincial capital, Daru.

Health in Western Province

“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 5 local doctors for a population of 228,000 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 90,000 people whatsoever.

Not surprisingly, statistics show that access to health services in the region has declined in recent years. Western Province is ranked 12th in provincial rankings and is just under the national average.

  • The rate of children under one year receiving the measles vaccination continues to remain at 27%, compared to the national average of 36%.
  • Over the period from 2012 to 2016 there was a reduction in childhood malnourishment; there were less severely malnourished children under five (those weighing less than 60% of the expected weight for their age).
  • 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% in 2008 to 9% in 2016. While there was an overall improvement in infant birth weights low birth weight is seen most frequently in the South Fly district.
  • The incidence of malaria in Western Province has been declining since 2008 from 330 cases per 1000 population to 191 per 1000 population in 2016.
  • Diarrhoeal disease serves as an indicator of water quality, food hygiene and personal hygiene. In the Western Province Diarrhoeal illness in children under five years has rose from 380 incidences in 2012 to 433 in 2016.
  • Antenatal care is a very important part of a women’s pregnancy. This includes monitoring during pregnancy, birth planning, and treatment or prevention of malaria or neonatal tetanus*. The percentage of pregnant women that attended at least one antenatal visit at a hospital, health centre or outreach clinic during their pregnancy has decreased from 72% in 2012 to 52% in 2016.

*Neonatal tetanus occurs in non-sterile home deliveries, and is mostly fatal (source)

 

Indicators as reported in NDoH 2019 SPAR

North Fly District

Middle Fly District

South Fly District

Outpatient Visits

4.6

1.8

2.2

Facility Births

57%

15%

45%

Antenatal Care

81%

21%

63%

Family Planning

342

80

215

Low birth weight

7.3%

1.3%

18.1%

Malnutrition

23%

15.5%

19%

Measles Vaccine

57%

7%

22%

Outreach Clinics

33

4

9

Pneumonia Deaths

1.4%

0.0%

1.1%

References

  • Pre Program Assessment for Health in Western Province, report prepared for the PNG Sustainable Development Program Limited
  • Western Province 2008 Annual Sector Review
  • 2013 Sector Performance Annual Review

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