“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 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 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 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.
“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.
*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% |
