A report released by ChildFund this week found that Papua New Guinea is one of the most dangerous places in the world to be a mother. So what's going on with Australia's number one recipient of aid?
There is shocking maternal health crisis unfolding less than 200km from our nation.
This week we heard that Papua New Guinea, Australia's closest neighbor and recipient of aid, has one of the highest rates of maternal and newborn deaths in the world.
A National Health Crisis: Maternal Deaths in Papua New Guinea, commissioned by ChildFund, revealed that a mother in PNG is 35 times more likely to die during child birth, than a mother in Australia.
This means that one in 120 women in PNG will lose their life due to a maternal cause, compared to Australia’s one in every 8,700.
That's a staggering statistic and highly concerning given Australia's concentrated investment into PNG for the past five decades.
What's going on?
The report points to location and lack of health infrastructure as the main barriers for maternal and infant health. Up to 85 per cent of PNG's population live in remote and rural areas, meaning the majority of babies born each year are born in areas where there is almost no access to doctors or hospitals.
Across the country, the percentage of women giving birth in clinics has declined in recent years, despite programs and legislation designed to encourage supervised births. In 2016, 40 per cent of women gave birth at a facility with a supervised birth attendant, down from 44 per cent in 2012.
The report highlights that small villages in PNG have for decades been serviced by basic clinics, which make up almost two thirds of the country’s health facilities. These aid posts are usually staffed by a community health worker with two years training, and are designed to service about 1,000 people. Rural health facilities comprise more than 95% of the facilities in PNG, but they struggle to keep up with the demands of a growing population.
In 2008, almost one fifth of all aid posts were closed because of shortages in funding, staff, and other resources, putting even further pressure on under resourced rural clinics already servicing large populations.
Unsupervised births contribute to the highest numbers of maternal and newborn deaths.
A major theme of the ChildFund report is that while other developing countries in the region have seen improvements in maternal death rates, in PNG, they have been deteriorating.
Added to this that three years on, PNG has yet to achieve its maternal and child health-related Millennium Development Goals (due to be met in 2015), and there is serious concern that the Sustainable Development Goals targets are not within reach.
Australia's approach to PNG: are we getting it wrong?
For years, critics of Australian aid have pointed to PNG as an ineffective use of aid; a country where overseas aid doesn’t work.
PNG remains the largest recipient of Australian Overseas Development Aid (ODA) in the region. In 2016-2017 it represented around 48.9 per cent of Pacific regional expenditure and 13.6 per cent of total Australian ODA.
In the federal budget for 2018-2019, the Coalition government announced it would provide $572.2 million in total ODA to PNG.
Since 2000, there has been a shift in Australia's ODA to PNG. The emphasis has gone from poverty alleviation to a paradigm that focuses on infrastructure, economic growth and governance.
The question must be asked; is it working?
After years of investment and billions of dollars, how could PNG be failing so significantly on what is considered a basic indicator of development?
Has Australian aid made an impact?
In this report were some telling signs for long-terms trends in the region, as well as clear missed targets.
The government has set out three clear objectives for the aid program in PNG. Only one of the three objectives was assessed as being 'on track' in the report.
One of the objectives to not quite met the target was 'enhancing human development' which includes the health sector.
Within this objective, the report put an emphasis on government ownership and accountability for administering health, rather than outcomes saying;
"In the past we have been comfortable with a narrow focus on technical outcome measures, such as counting health service utilisation, immunising kids and supervising births. These are essential, but our health investments must afford equal importance to addressing the political economy of health – understanding incentives, building institutions, and enabling leadership."
What has been recommended by the sector?
In 2015, ACFID made a submission into the Inquiry into the delivery and effectiveness of Australia's bilateral aid program in PNG.
Among 15 recommendations, one clear directive was to: Invest in strengthening PNG’s primary education and local health care facilities and systems, particularly in remote and hard to reach areas.
ACIFD pointed to research conducted jointly between the ANU’s Development Policy Centre and the National Research Institute of PNG that highlighted significant challenges facing both the health sector in PNG; in one instance it was found that only about 40 per cent of health clinics have electricity and refrigeration, less than half have enough toilets and less than a quarter have beds with mattresses for patients.
ACFID in their submission highlighted a significant point: infrastructure can only be effective and trade and private sector-led growth can only 'flourish', where there are strong institutions, property rights, natural resource management, and when poor health and education services are addressed.
ACFID went on further in the report to say that 'investments in infrastructure should focus on community infrastructure (such as school buildings or local health clinics) in regional areas to strengthen health and education outcomes for those living in poverty'.
ChildFund Australia continues to work on the ground in PNG, aiming to bridge the gap between remote villages and health clinics in major centres, as well as running programs to train and equip healthcare workers.
Quoted in the report, Olive Oa, head of ChildFund PNG’s health program, said “If we want to improve the statistics for the country as a whole, the first thing we have to do is improve and strengthen the services in the rural areas, the rural villages."
Australian aid, can and must continue to play a critical part in this.