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ADI Integrated Rural Health Patrols & In

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ADI Integrated Rural Health Patrols & In ADI Integrated Rural Health Patrols & In-Service Training in New Ireland, PNG 5-Year Evaluation: 2011-2015 Analysis and Key Findings Dr Klara Henderson August 2016 1 Acknowledgements This report relied on the input of many, from ADI staff in the Sydney Head office to staff in Kavieng. Patrick McCloskey conceived this work and provided ongoing guidance, input and support while staying impartial. Gemma Tuxworth went out of her way to introduce me to the key people in Kavieng. Dianne O’Brien conducted the financial analysis, spending considerable time to document patrol and in- service costs, this work is undoubtedly going to be useful in an ongoing sense. And finally Judy Lambert’s input during the work ensured the project was heading in the right direction. Thank you to all those of provided their interview time. 2 Table of Contents Acknowledgements ...................................................................................................................................................... 2 Table of Contents ......................................................................................................................................................... 3 List of Tables ................................................................................................................................................................. 4 List of Figures................................................................................................................................................................ 4 Executive Summary ...................................................................................................................................................... 5 Structure and Purpose of Report .................................................................................................................................. 8 Methodology ................................................................................................................................................................ 9 The PNG and New Ireland Health Context .................................................................................................................. 10 Current status - New Ireland .......................................................................................................................................... 12 Report Findings .......................................................................................................................................................... 15 Objective 1 ................................................................................................................................................................. 15 Patrol Staff Composition ............................................................................................................................................ 17 Ideal Patrol Team Composition .................................................................................................................................. 19 Topic Coverage for Group (In Service) and Patrol (Case Based) Training .................................................................. 26 Health Worker Access to Patrol Staff for Training ..................................................................................................... 27 Health Workers at In-Service ..................................................................................................................................... 28 In-service Topics ......................................................................................................................................................... 30 Trainers at In-Service ................................................................................................................................................. 31 Health Facilities .......................................................................................................................................................... 32 Health Workers .......................................................................................................................................................... 32 Health Worker Load and Support .............................................................................................................................. 35 Financials .................................................................................................................................................................... 37 Provincial Government Funding................................................................................................................................. 37 User Fees .................................................................................................................................................................... 37 Costings ...................................................................................................................................................................... 39 Summary of Recommendations for Objective 1 .......................................................................................................... 42 In Relation to the Patrol Team: .................................................................................................................................. 44 In Relation to the Doctor Placement: ........................................................................................................................ 44 Objective 2 ................................................................................................................................................................. 46 Objective 3 ................................................................................................................................................................. 48 Funding and high-level decision making .................................................................................................................... 49 New Ireland Health Education Committee ................................................................................................................ 49 Establish regular and sustainable PNG medical participation in patrols ................................................................... 49 Patrol and in-service management ............................................................................................................................ 50 Acronyms ................................................................................................................................................................... 51 References .................................................................................................................................................................. 52 Annexure 1: Health Facilities and Aid Posts (November 2015 status) ......................................................................... 53 Annexure 2: Clinical Survey Demographics and Scores ............................................................................................... 57 3 Annexure 3: Cost categories 2013-2015 ...................................................................................................................... 59 List of Tables Table 1: PNG health capacity and status ............................................................................................................................ 10 Table 2: Maternal health data ............................................................................................................................................ 12 Table 3: Diabetes data ........................................................................................................................................................ 12 Table 4: TB data .................................................................................................................................................................. 13 Table 5: Select indicators for New Ireland - National Health Plan ...................................................................................... 13 Table 6: Summary of key health issues - relevant for patrols ............................................................................................. 15 Table 7: Patients seen and services delivered .................................................................................................................... 20 Table 8: Patients seen by remoteness ................................................................................................................................ 20 Table 9: Health facility case based and group based teaching by remoteness .................................................................. 21 Table 10: Timeline of in-service, attendees and topics ...................................................................................................... 24 Table 11: In-service costs .................................................................................................................................................... 25 Table 12: Health worker positions and their organisational base ...................................................................................... 29 Table 13: Health worker load and support ......................................................................................................................... 35 Table 14: Patrol costs, and cost centres ............................................................................................................................
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