Statistical Indicators For Monitoring Progress Toward End-Decade Goals

PNG Annex A.1.

END DECADE REPORT

WORLD SUMMIT FOR CHILDREN DECLARATION AND PLAN OF ACTION AND THE GLOBAL GOALS FOR CHILDREN IN THE 1990S

PAPUA NEW GUINEA PNG Annex A.1.

END DECADE REPORT

WORLD SUMMIT FOR CHILDREN DECLARATION AND PLAN OF ACTION AND THE GLOBAL GOALS FOR CHILDREN IN THE 1990S

PAPUA NEW GUINEA

Table Of Contents

PART I. INTRODUCTION AND BACKGROUND PAGES 1 - 7

Part II. Process of End Decade Review Pages 8 - 9

Part III. Actions at National and International Levels Pages 10 –14

Part IV. Specific Actions to Promote the Wellbeing of Children Pages 15 –23

Part V. Lessons Learned and Future Directions Pages 24 – 30

Annexes

A. Leadership Forum PNG Annex A.1.

B. PNG and the Global Agenda C. Statistical Indicators

The Department of National Planning and Monitoring

IN CO-OPERATION WITH

UNICEF-PAPUA NEW GUINEA

14 DECEMBER 2000 PNG Annex A.1.

1.1. PNG – AN OVERVIEW

Papua New Guinea occupies the eastern half of the sub-continental island of New Guinea plus the islands of the Bismarck Archipelago and the northern Solomons group (see Figure 1). In terms of both landmass and population, PNG is the largest of the twenty-two nations and territories that comprise the Pacific Islands Region.

The population, currently estimated at 4.7 million, is dispersed across a land area of 452,900 square kilometres and a sea area of over two million square kilometres (Exclusive Economic Zone). The country is comprised of eight large islands and over 300 smaller islands which together account for tremendous geographic diversity. The mountains of the rugged interior of the main island jut to elevations of over 4,000 meters while outlying islands may lie just a few metres about sea level.i Geographical diversity has in turn spawned biological diversity. It is estimated that PNG, which comprises only 1% of the world’s landmass, contains 7% of the world’s surviving bio-diversity.

Geographical diversity has also spawned cultural diversity; over 860 distinct ethnic and language groups reside in the archipelago. One-quarter of the languages spoken in the world today are spoken only in PNG.

In terms of natural resources, PNG is a wealthy nation. It has extensive reserves of gold, copper, oil and natural gas together with vast forests and productive agricultural lands. With a GNP per capita of US$890, PNG is

Table 1 PNG: Facts in Brief

Population (est. 2000) 4.7 million Human Deprivation Index 43.7 Population growth rate 2.3% Life Expectancy at Birth 54 Doubling period 30 years Infant Mortality (1991-6) 69 GNP per capita (1998) US$890 Under 5 Mortality (1991-6) 100 Population in poverty (1996) 37% Maternal Mortality (1996 est.) 370 Human Development Index 0.363 Adult Literacy (1990) 45% PNG Annex A.1.

officially classified as a middle income country (World Bank, 1998). However, economic wealth is concentrated in a narrow and predominately urban modern economic sector. Living standards for the vast majority of the population, especially the 85% of people living in rural areas, are more akin to those of a low-income sub-Sahara country. This is reflected in PNG’s ranking on social indicators (see Table 1 and Annex C).

PNG is a parliamentary democracy that gained independence from Australia in 1975. Since independence, economic development has been driven by mineral extraction (gold, copper and more recently oil and natural gas), commercial logging, and export tree-crops (coffee, cocoa, copra, and palm oil). Economic performance is tied to world market prices for this relatively narrow range of export commodities. Over the past decade, PNG has experienced a series of economic shocks, natural disasters, and political upheavals that have undermined government’s capacities to provide basic services, expand employment and earning opportunities, and improve living standards. These events have exacerbated weaknesses in government’s administrative structure. Government has responded with a wide-ranging programme of economic, administrative, and political reforms. Although initiated in 1995, the reform process has accelerated in the last eighteen months under the current government headed by Prime Minister Sir Mekere Morauta.

The cornerstone of the current government’s initiative is the National Charter for Reconstruction and Development (Inset #1). PNG Annex A.1. INSET #1: CHART ON RECONSTRUCTION AND DEVELOPMENT GOVERNMENT’S DEVELOPMENT AGENDA FOR 2000-2002

This charter commits all levels of governmentGives (national, priority provincial, to: -and local) to people-centred development focusing on health, education, rural infrastructure and primary production. This commitment, together with other elements of reform, has restored investor confidence; this in turn is fuelling economic  Primary health care, education, rural infrastructure, and primary industries  Partnership and participation  Devolution of powers to provincial, district, and local government

Targets to achieve: -

 Fully operational health aid posts  Basic medical supplies in all rural health centres  Fully equipped elementary and primary schools  Upgraded roads, seaports, airports, communications, and power services  Rehabilitated agriculture farming centres  Increased primary production from villages and small holder producers

Strategies for health: -

 Improve health service delivery, especially at district level  Provide adequate budgetary support for health promotion, family health, disease control, water and sanitation, and essential drugs and other health supplies  Upgrade and maintain buildings and equipment  Strengthen partnerships with churches and NGOs  Create and fund community health workers  Determine the underlying reasons for poor health indicators Strategies for basic education: -

 Increase access to elementary, primary, and secondary education  Renovation existing classroom and staff accommodations  Provide school curriculum materials  Train new teachers and provide in-service training for existing teachers  Develop and implement appropriate curricula  Improve educational management and increase efficiency  Strengthen partnerships with churches and NGOs  Strengthen inspection and monitoring  Develop and implement vocational and technical training curricula and skills for community living. PNG Annex A.1.

recovery. Three large mineral projects (an oil refinery, an undersea gas line, and a nickel-copper mine) are under construction. IMF-World Bank economic stabilisation loans have recently been approved and the value of overseas development assistance has doubled (1998-2001). PNG Annex A.1.

Despite many challenges, government remains committed to sustainable and equitable human development and to the global development agenda of the 1990’s. PNG has adopted at the highest level most of the policies, declarations, treaties, and plans that comprise this global agenda. These include, but are not limited to: the World Summit Declaration on the Survival and Development of Children (1990), the CRC (1993), and CEDAW (1994). (Annex B summarises government’s responses to the global development agenda).

1.2. Situation of Children

The situation of children is similar to that of low-income countries. Infant, child, and maternal mortality rates are high; most deaths could be prevented if the population had better living conditions and better access to health services. Poor nutrition (protein-energy malnutrition and iron-deficient anaemia) contribute significantly to mortality. Poor nutrition is a function of low literacy and education levels, food insecurity, poor weaning and child feeding practices, high levels of infectious diseases (especially diarrhoea and malaria), and poor access to safe water and improved sanitation.

The generally poor health situation is now exacerbated by the rapid spread of HIV infection. PNG’s first HIV infection was diagnosed in 1987. By September 2000, the cumulative number of persons infected reached 3,145. Reported cases represent only the “tip of the iceberg” since very little testing is actually done and high levels of infection normally present in the population can mask the manifestations of AIDS. Estimates of the actual number of persons affected by HIV-AIDS range from 5,000- 15,000. While infection is predominately through heterosexual contact, mother-to-child transmission accounts for 8% of reported cases and this proportion is steadily rising. An estimated 1,100 children have already been orphaned by AIDS; this number will also increase.ii Government formulated an initial response to a possible AIDs epidemic in 1987; these efforts have intensified with the formation of a National AIDS Council in 1997. Despite vigorous awareness and prevention activities, experts acknowledge that it will take 5-10 years of concerted effort to "turn the tide” on the epidemic.

Health data show wide variation from one year to the next. Apparent improvements are quickly counterbalanced by subsequent deterioration. In part, this reflects weak surveillance and intermittent reporting but it is also indicative of discontinuity in services. Although stated government policy strongly favours primary health care, managerial capacity to translate policies into action is severely constrained. Many initiatives have been launched with donor assistance and result in short-term localised improvement in health indicators but have not been sustainable by government’s own efforts. A Child Survival Crash Programme implemented in 1994-97 in direct response to government’s commitments at the World Summit for Children is an example of this phenomenon. Despite political and financial commitments, both domestic and external, mortality, morbidity, and health service indicators show little improvement over the past decade (Annex C). This is a major concern to government. Responses include a restructuring of health delivery systems together with major new investment in rural health infrastructure (Inset #2 and Annex B).

Although health improvements have stagnated for much of the 1990s, the situation in education has improved. Spurred by the Global Education For All Initiative, government introduced a programme of education reform in 1993. The reform programme is expanding access to schools, increasing parent and community involvement, and making curricula more relevant. Ultimately, the programme aims to achieve universal access to and participation in basic education and universal progression to at least grade eight. PNG Annex A.1.

Throughout the decade, the focus by government, UNICEF, and the donor community has been to improve the health and education of children and families. Although child protection and participation were recognised to be important, there has been a prevailing belief that the Melanesian family and clan systems adequately address these matters. The Working Group on Children’s Rights that preparedINSERT the #2 initial country report on implementation of the CRC, (hereafter referred to as the ‘CRC Report’), strongly questioned this assumption.R InESTRUCTURING the report, the Committee AS A STRATEGY calls for new FOR initiatives PROGRESS : “THE NATIONAL HEALTH ADMINISTRATION ACT OF 1997”

From Independence in 1975 to the mid-1990s little improvement was recorded in health indicators (Annex C). Although a series of health plans and programmes were developed and launched with great optimism and fanfare, virtually none achieved long-term sustained and nation-wide results. By the mid-1990s the health system, especially in rural areas, was approaching a state of collapse. Government attributed the underlying cause of the unfavourable situation to “(over) decentralisation of resource management, lack of control and co-ordination, withdrawal of doctors from district health centres, creation of large provincial hospitals, and lack of political will and commitment.” The result in government’s own words was “a complete lack of direction, low staff morale, poor performance, and lack of community confidence in the health system” (DOH, National Health Plan 2001-2010, Volume I).

Government responded to the situation with the “New Organic Law on Provincial Governments and Local Level Governments” (1995). The “Health Administration Act of 1997” translated the broad principles of the Organic Act into the health care system. The Health Administration Act:

 Provides the legal mechanisms for linking and consolidating the functions of all agencies involved in the delivery of health services;  Legitimises administrative directives that in the past have been ignored thus resulting in many health programmes and policies not being implemented.  Provides a clear delineation of administrative functions by the Department of Health, Provincial Health Administrations, and District Health Services.  Establishes a National Health Board, Provincial Health Boards, and District Management Committees to assist in carrying out the various health functions.  Requires private practitioners and NGOs delivering health services to provide health information to the NDOH to compile the National Health Information System.  Authorises the Department of Health, Public Hospitals, and Provincial Governments to enter into contractual arrangements with selected NGOs to provide health services.  Empowers the DOH to develop and set standards for the national health system.

The Act complements the “Public Hospital Act of 1994” which creates semi-autonomous hospital boards to administer institutions in accordance with nationally defined standards.

Synposis extracted from: Department of Health, “Mid-Term Review of the National Health Plan 1996-2000,” Port Moresby, June 1998, page 66. PNG Annex A.1.

to document the situation of children in terms of protective measures in the home (abuse and neglect), in the community (exploitation), and in the justice system (children in conflict with the law). It is the committee’s contention, as reflected in the final government-approved report, that family breakdown, poverty, economic hardship, and the spread of HIV-AIDS, have seriously undermined the PNG Annex A.1.

capacities, and even the willingness, of families and communities to protect their children and ensure their basic rights. Government is mounting various responses to the Committee’s recommendations as described in Sections III and IV of this report.

The CRC report also highlights the need to better document the situation and protect the rights of children affected by armed conflict. In the North Solomons Province, an estimated 60,000 children and their families have been affected by an eleven-year war of succession during which virtually no basic services were provided. Although it is expected that a peace accord and agreement on provincial autonomy will be signed in January 2001, this will usher in a lengthy period of reconstruction.

On the western side of the country, political unrest in the Indonesian Province of Irian Jaya has prompted Indonesians of Melanesian descent to flee into PNG across the lengthy and predominately unpatrolled border. As of 1998, an estimated 10,000 refugees lived along the border, approximately 4,000 in an “official” refugee camp operated by the PNG Government and the Catholic Church and the rest in informal settlements. iii Since 1998, political unrest in Indonesia has intensified and the number of refugees has steadily increased although there are no precise figures available at the time of this report. Recently GoPNG has requested assistance from UNHCR. As a result, UNHCR recently announced that it will establish a permanent in-country “presence” in 2001.

1.3. PNG AND THE WORLD SUMMIT FOR CHILDREN

PNG was one of four Pacific Island nations represented at the Head of Government level in the World Summit for Children 1990. The PNG delegation was led by the then Prime Minister Sir Robbie Namaliu who signed the World Summit Declaration and initiated follow-up action which resulted in government ratifying the International Convention on the Rights of the Child in 1993. Prime Minister Namaliu, together with Prime Minister Walter Lini of Vanuatu, put children on the agenda of the 1992 Pacific Forum meeting. This was the first time that the Forum, the Pacific’s primer inter-governmental body, had addressed social development, until then the exclusive purview of the South Pacific Commission (now renamed the ‘Pacific Community’). The ensuing Forum Communiqué called for a Pacific-wide Conference on Children subsequently held in Noumea in 1993. Once again, Papua New Guinea assumed a leadership role in that conference from which emerged unanimous endorsement of the principle of “First Call for Pacific Children” and adoption of a Pacific Regional “Agenda for Action.”

International and regional developments prompted the GoPNG to look more deeply into the situation of their children at home. A 1993 “Call to Action” report stated publicly for the first time in a domestic publication that despite its middle-income status, PNG ranked alongside the least developed countries on social indicators. Furthermore, the social situation was deteriorating. These findings provided the impetus for the Child Survival Crash Programme (1994-1997) which aimed to raise immunisation levels and revitalise maternal and child health services. This programme constituted the immediate response by the health sector to the World Summit.

Over the same period, parallel developments were underway in the education sector. PNG participated in the Jomtien Conference on Education for All (1990) and was a signatory to the ensuing EFA Declaration and Plan for Action. The objectives and strategies espoused globally echoed past recommendations for education reform in PNG that dated as far back as 1974.iv Drawing strength from the global EFA initiative, an Education Reform Task Force was appointed in 1991. From the Task Force’s work PNG Annex A.1.

emerged a framework for education reform. This work has constituted the main response by the education sector to the World Summit and the Education for All Plan of Action.

The foci then of World Summit follow-up were the sector-specific responses by health and education. A 1994 review found work in-progress toward all of the mid-decade goals. Very few goals, however, were realistically considered to be achievable by 1995, (Inset #3).

A consolidated National Plan of Action for Children (NPA) was not prepared nor was a formal government mechanism established to monitor the situation of children. UNICEF’s situation analysis process did, however, provide one review mechanism. A joint UNICEF-Government report on the Situation of Children, Women, and Families was released in 1996. That report highlighted progress and challenges in the framework of both the CRC and the World Summit goals.

There were two main reasons for not preparing a NPA. One, there was not a felt need for a specific child-focused plan since government’s plan was in essence the already published health and education sector plans. Two, there was no central body positioned to co-ordinate NPA preparation.

As of 2000, the situation has changed. The ‘Revised Organic Act of 1995,’ strengthened

INSET #3: THE MID-DECADE GOALS IN PAPUA NEW GUINEA

Goal Prospects for Achieving

 Achieve 80% coverage with all antigens………………………….… Achievable with effort  Eliminate neonatal tetanus…………………………………………... Very challenging  Reduce the incidence of measles and measles deaths…………….…. Very challenging  Eradicate polio…………………………………………………….…. Achievable with effort *  Virtual elimination of Vitamin A Deficiency……………………….. Achievable with effort  Universal iodisation of salt…………………………………………... Achievable with effort *  Achieve 80% usage of ORT…………………………………………. Very challenging  Make target hospitals “baby friendly”…………………………….… Achievable with effort  Strengthen basic education, increase enrollment and retention by one-third……………………………………………………………... Very challenging *  Increase water supply coverage by one-quarter and sanitation coverage by one-tenth……………………………………………….. Very challenging  Ratify the CRC………………………………………………………. Achieved *

Source: UNICEF-PNG, “Progress of PNG Toward the 1995 Mid-Decade Goals,” July 1994. Note: ‘*” Indicates that the mid-decade goal was achieved by or before the end of the decade. PNG Annex A.1.

the roles of national government in policy formulation and planning. A Department of National Planning and Monitoring (DNPM) was established to supervise a “bottom up” planning process emanating from the ward level. (The ward is the lowest level of governance in the PNG system). The DNPM is also mandated to co-ordinate government’s responses to cross-sectoral issues such as women and children.

As the planning structure has evolved, a felt need for a National Plan of Action for Children has also emerged. The DNPM, in conjunction with the sectors, is now committed to developing an NPA for the period 2001-2010 as early in 2001 as practical. To this end, a leadership forum was recently convened to provide cross sectoral and citizen input into the NPA process. The recommendations emanating from the Forum are summarised in Annex A.

1.4. PNG AND THE CRC

PNG officially ratified the CRC without reservation in 1991 although instruments of ratification were not deposited with the United PNG Annex A.1.

Nations until 1993. While GoPNG was cognisant of its reporting responsibilities under the CRC, the lack of a focal point for children and the many crises which plagued the nation during the mid-decade, delayed preparation of the Initial Implementation Report.

In 1997, two government officers, one from Foreign Affairs and one from Planning, were invited by UNICEF to participate in a Pacific Regional Consultation on CRC Reporting held in Fiji. The workshop inspired the planning officer who attended to advocate with her superiors for establishment of an inter-sectoral committee to address CRC reporting requirements. Still, it took another two years before an inter-sectoral Working Committee on the Rights of the Child was actually convened.

Under the auspices of the Working Committee two parallel processes were initiated: (1) a process of situation analysis supervised by DNPM and (2) a process of legal review supervised by the Department of the Attorney General. The final report consolidates the outputs of both processes and was approved by the National Executive Committee in October 2000. Five areas for action are highlighted beyond the often-reported survival and development issues.

1) Law reform: Twenty pieces of substantive national-level legislation affecting children were identified to require amendment. Many PNG laws were inherited from the Australian Colonial Administration and some had been previously inherited by Australia from England. There is much in the law that is antiquated, culturally inappropriate, and contrary to the CRC and other international treaties. 2) Child protection: Law reform, public education, and a revitalised social welfare system are needed to ensure that PNG children enjoy all of their rights. 3) Action Plan: To ensure orderly and progressive action toward addressing all the rights under the CRC, the Report calls for a National Plan of Action that will address the “whole child” and clearly delineates priorities and responsibilities for action. 4) Monitoring: Data for assessing and monitoring the situation of children and compliance with the CRC is fragmentary and dated. The report recommends that a sustained surveillance and monitoring system be created. 5) Focal Point: To develop a national plan of action and a monitoring system, it is necessary that a focal point for children be designated. The focal point could take one of several forms and be attached to various institutions. Options include: (a) the Department of the Attorney General that is ideally suited to co-ordinate legal and judicial reform; (b) the Child Welfare Council and the Department of Home Affairs that are well-positioned to address protection issues but less well situated to deal with health and education; (c) the Department of Planning and Monitoring that has a mandate for inter-sectoral issues; (d) a National Children’s Council; or (e) a PNG Human Rights Commission. Of the five, neither the National Children’s Council nor the Human Rights Commission currently exists although both are under consideration. End Decade Report: Papua New Guinea

2.1. MANDATE FOR REPORTING

From 2000 onward, the Department of National Planning and Monitoring (DNPM) has a clear mandate to co-ordinate government’s response on inter-sectoral issues. Co- ordinating government’s initiatives on children is then a responsibility of DNPM - a responsibility the Department has eagerly embraced.

Under the auspices of the DNPM, two working committees have been created: (1) the Working Committee on the Rights of the Child; and (2) the Inter-Agency Working Committee on Children.

2.2. WORKING COMMITTEE ON THE RIGHTS OF THE CHILD

The Working Committee on the Rights of the Child is an inter-sectoral body comprised of representatives from government and civil society. The committee had a specific and time-limited mandate to draft Government’s initial CRC Report. The committee has fulfilled its mandate and is no longer functional. Most of the committee members, however, continue to be active in children’s issues. Some are working with the Department of the Attorney General on law reform; others are working with the Department of Home Affairs on child welfare, child abuse, and birth registration; still others are working with the Department of Labour on child labour issues. The CRC Report has been an important source of information for this End Decade Report and will form the basis for the NPA to be prepared in 2001.

2.3. INTER-AGENCY WORKING COMMITTEE ON CHILDREN

The Inter-Agency Working Committee on Children, chaired by DNPM, is comprised of representatives of government departments that have specific responsibilities for protecting and promoting children’s rights. Membership includes representation from Health, Education, Home Affairs and Youth, the Attorney General, and Labour and Employment. This committee co-ordinated government’s input into the mid-term review of UNICEF’s Country Programme for Children (September 2000) and has helped to prepare this End Decade Report. This committee will also be the focal group for the NPA in 2001.

While the End Decade report has been the product of inter-government consultation centred at the national level, the NPA process will be more participatory. Although the process to be followed has not yet been fully delineated, work has already begun to solicit input. For this purpose: (1) a leadership forum was held in October 2000 (Annex A); (2) a youth forum will be held in mid-December; and (3) a series of regional meetings are in-progress on child welfare and legal reform. With assistance from UNICEF and other donors, several special purpose studies have also been commissioned to feed into the NPA formulation process (e.g. studies on birth registration, child abuse, and child labour). 15 End Decade Report: Papua New Guinea

2.4. OVERVIEW OF PROGRESS

Inset #4 presents an overview of PNG’s status vis-à-vis the Global Goals for children as of 2000. Annex C provides supplementary statistical documentation.

16 End Decade Report: Papua New Guinea

17 End Decade Report: Papua New Guinea

INSET #4 END DECADE REVIEW PNG STATUS ON SELECTED DECADE GOALS

GLOBAL GOAL FOR CHILDREN PNG STATUS 2000

 Reduction of infant mortality by one-third……………………….. ….. In progress; achievable  Reduction of child mortality by one-third……………………….…….. In progress; achievable  Reduction of maternal mortality by one-half…………………………. Inadequate data  Reduction in childhood malnutrition…………………………….…….. No progress  Achieve universal access to safe drinking water…………………….. In progress; challenging  Achieve universal access to sanitary excreta disposal……….…….. Significant progress  Universal access to basic education………………………………….. Significant progress  Reduction in adult illiteracy by one-half………………………………. No progress  Improved protection of children in difficult circumstances………….. No progress  Meeting the health and nutrition needs of women and girls………... In progress; challenging  Universal access to family planning…………………………….…….. Inadequate data  Improved access to prenatal and obstetric services………………… In progress; achievable  Reduction of low birth weight to 10% or less………………………… Achieved  Reduction of iron-deficient anaemia in women by one-third……….. Inadequate data  Elimination of iodine deficiency disorders……………………………. In progress; achievable  Elimination of Vitamin A deficiency and associated disorders……... Inadequate data  Exclusive breastfeeding for 4-6 months; continued breastfeeding with complementary feeding for 1-2 years…….……………………... Achieved  Universal growth monitoring…………………………………………… Inadequate data  Ensure household food security………………………………………. In progress; achievable  Achieve and maintain immunisation levels of 80% or higher………. In progress; achievable  Eradication of polio……………………………………………………… Achieved  Elimination of neonatal tetanus………………………………….…….. In progress; achievable  Reduction in measles cases and deaths……………………….…….. In progress; achievable  Reduction in diarrhoeal cases and deaths…………………………… Inadequate data  Reduction in ARI cases and deaths…………………………….…….. Inadequate data  Expansion of early childhood development activities……………….. Significant progress  Increased learning through media and non-formal education.…….. Inadequate data  Implementation of the CRC……………………………………………. In progress; challenging  Implementation of IMCI………………………………………………… Initiated 2000  Increased awareness of HIV-AIDS and means of prevention……… In progress; achievable  Ratification of the CRC…………………………………………………. Achieved  Ratification of the CRC Optional Protocol on Sexual Exploitation…. In progress; achievable  Ratification of the CRC Optional Protocol on Child Soldiers……….. In progress; achievable  Ratification of the ILO Convention on the Worst Forms of Child Labour……………………………………………………………………. Achieved  Ratification of the International Land Mines Treaty…………………. In progress; achievable

18 End Decade Report, PNG

3.1. PNG AND THE GLOBAL DEVELOPMENT AGENDA

The PNG Government is fully committed to the principles of equitable and sustainable human development - principles enshrined in the Constitution. Accordingly, government has assumed an active role in the various international development forums of the 1990s and in virtually all cases has signed the ensuing resolution, declaration, or plan of action. Annex B summarises PNG’s actions which respond to the various elements of the global agenda including: children, child labour, education, food security, HIV-AIDS, health, literacy, nutrition, population, poverty, sustainable development, and gender equality.

Government’s commitment to the global agenda has resulted in direct and measurable benefits to PNG citizens. The Global Education for All Initiative inspired PNG educators and helped to mould the Education Reform Programme. Reform has in turn resulted in a system of basic education that is more accessible, more appropriate, and of higher quality than the system of the past.

The Department of Health has worked closely with UNICEF and WHO in the global drive for “Universal Child Immunisation” (UCI). Although PNG has yet

Allocation of Governm ent's Education Kina, 1999-2001 Voc- Literacy 1% Tech Other 6% 5%

Tertiary 19% Basic 69% to achieve UCI status, increased immunisation coverage has resulted in fewer cases of immunisable diseases. Earlier this year, PNG was awarded polio-free certification by WHO.

3.2. RESOURCES FOR CHILDREN

Recently government has promulgated a new domestic development agenda that gives priority to (1) basic education, (2) primary health care and rural health services, (3) rural infrastructure, and (4) primary production. These priorities are reflected in government’s resource allocations. Spending for health and education has increased by 31% since 1999. These two sectors now account for almost one-quarter of total government expenditures. Twenty-nine percent of health resources are allocated for rural and primary health care. Sixty-eight percent of education resources are allocated for basic education (elementary, primary, and secondary). This provides an unequivocal indicator of the depth of government’s commitment to the Global Agenda for Children.

Allocation of Government's Health Kina, 1999-2001 Other Rural & 19% PHC 29%

Training 8%

Hospital 44%

3.3. SOCIAL MOBILISATION

Social mobilisation in PNG is challenging. With 860 cultural groups, there is tremendous diversity in language and “world view.” Literacy levels are low. Walking and word-of-mouth are the main modes of transportation and communications for most rural residents. Even the radio has limited reach; only 32% of PNG families have a radio in their home (1996).v

Media and printed materials are important if for no other reason than they influence urban-based policy makers. However, to change attitudes and behaviours, interpersonal networks are the most influential. This section will briefly outline “interpersonal networks” that are or could be mobilised on behalf of children and will subsequently highlight some of the social mobilisation initiatives in progress.

Interpersonal Networks

In rural Papua New Guinea, churches are the most important force in the community. They reach even the very remote areas that are seldom visited by government agents. They bring a sustained presence that moulds attitudes, perceptions, and behaviours. For most communities, churches are the main sources of information and non-formal learning. Churches also own and operate much of the rural social infrastructure, e.g.

 46% of rural health centres;  50% of hospitals;  50% of primary schools; and  33% of secondary schools.

For over 125 years, churches have been the primary, and often the only, provider of non-formal literacy education. Today, churches are also important providers of social welfare services.

Besides their role in service delivery, most churches sponsor affiliated organisations such as youth and women’s groups. In many denominations, groups are organised into district, provincial and national networks. In the case of the churchwomen’s groups, these networks were the forerunners of the National Council of Women.

Besides churches, there are other community-based organisations. Most are active in social development, child and family welfare. There is also a large and growing network of non-government organisations,vi (the CRC Report indicates 150 NGOs were active in 1998). Most NGOs operate in the social sectors, often with a rights focus (although they may or may not use the CRC and CEDAW as points-of-reference). In recent years, NGOs have become important

providers of social welfare and counselling services for children and families with special needs (disabled; victims of violence, exploitation or abuse; families living in extreme poverty; AIDS victims; orphans; and delinquents).

While NGOs provide essential services, they are limited in their outreach by resource

Examples of NGO Partnerships for Children and Issues Advocated

 Intersectoral Social Mobilisation group – immunisation, rights, HIV-AIDS  YWCA – domestic violence, child abuse, rights, gender  ICRAF – CRC, CEDAW, gender  National Cultural Commission – drama training, HIV-AIDS  Baua Baua Theatre – rights, violence prevention, reproductive health, HIV-AIDS  Red Cross: disaster relief and emergency operations, primary health care, rights, rehabilitation  Save the Children: children & women’s rights, violence prevention, primary health care, community based rehabilitation, non- formal education, NGO capacity building  Foundation for People and Community Development – social mobilisation, HIV- AIDS  National Media Council – children’s rights (general), participation of children in their communities, children’s right to seek information and be heard  Special Parliamentary Group on Children – rights and protection 23 End Decade Report, PNG

constraints, both human and financial. Most depend on volunteerism for much of their human resource requirements. For cash, most depend on overseas development assistance. Because NGOs tend to be vocal about what they perceive to be government shortcomings, NGO-government relations are sometimes characterised by mutual distrust rather than by respect and co-operation.

Government extension workers are important forces for community education and mobilisation. However, their capacity to influence attitudes may be impeded by (1) sporadic contact, especially in remote areas and (2) frequent rotation of personnel. Elementary reform has the potential to revolutionise government’s capacity for social change. Ultimately elementary reform will deploy 14,000 trained elementary teachers directly into villages. These teachers can be powerful forces for change if they are effectively mobilised and supported.

Work in Progress

Early in the Child Survival Crash Programme, health officials recognised a need to harness multiple channels of communications through which to encourage immunisation. For this purpose, an Inter-Sectoral Social Mobilisation Group was formed. The group has diverse membership that draws from the public sector, NGOs, and community representatives from the Port Moresby area. Today, the group continues to support immunisation, but has expanded its focus to include child rights and HIV-AIDS.

The media has also been mobilised for children. UNICEF and government use special events to capture media coverage for children (e.g. launch of the international publications such as the State of the World’s Children and the Progress of Nations, the International Day of Children’s Broadcasting, United Nations Day, and others). At their own volition, the national newspapers have incorporated “children’s pages” as regular features and national and provincial radio stations have added children’s programmes to their schedules. Port Moresby based media representatives are now forming a “Media Group for Children.” This group will aim to provide more systematic and in-depth coverage of children and children’s issues. The PNG Media Council will host the Pacific Islands News Association conference in 2001. The Council hopes to make children’s coverage the theme of that meeting.

Drama is an indigenous art form in PNG. There are literally hundreds of community groups using drama for cultural observance, entertainment, and education. More recently the concept of “social action theatre” was introduced during the Child Survival Crash Programme. Although several drama groups were involved, one in particular – the Baua Baua group from East Sepik Province - gained national and international acclaim. This group, working in co- operation with the National Culture Commission, is now training other groups in drama for HIV-AIDS prevention.

3.4. MONITORING AND SURVEILLANCE 24 End Decade Report, PNG

Both the Departments of Health and Education have recently introduced new standardised information systems. While data thus generated is important, it reflects only the sub-set of the population with access to government services. Because access to services is poor in rural areas, data derived from routine reporting cannot be generalised to the population at large.

To collect information about the general population, it is necessary to rely on surveys. The two most important on-going surveys are the census (conducted at ten year intervals) and the Demographic and Health Survey (conducted a five-year intervals). Another survey that was invaluable in preparing this End Decade Report was the 1996 poverty survey conducted by the World Bank.

It is widely recognised by child advocates that available information does not adequately support monitoring of the many aspects of children’s rights. To improve surveillance and monitoring, several activities are underway or planned:

 The Department of Home Affairs has begun work to strengthen civil registration;  DNPPM and UNICEF are working together to operationalise the “Child-Info” system of computerized data storage and retrieval;  In 2001, the Department of Health will begin surveys into parental knowledge and practices in caring for sick children; for this work, the Department will use standard Integrated Management of Childhood Illness (IMCI) protocols adapted specifically for PNG.

3.5. NATURAL DISASTERS

Over the past decade, PNG has been devastated by an unprecedented series of disasters. Man-made disasters have included the refugee crisis in the west and the war in Bougainville. Natural disasters have included volcano eruptions, tsunami, earthquakes, typhoons, landslides, extended droughts, and even killer frosts. The Office of Disaster Management and Emergency Services within the Department of Provincial Affairs co-ordinates disaster management in co- operation with the PNG Chapter of the Red Cross. This Office is assisted by disaster co-ordinators appointed by each of the provincial governments.

In the past, government’s strategy has focused on co-ordinating efficient and effective relief operations. Since 1999, a new more comprehensive disaster management strategy has been implemented. This strategy combines disaster prevention and mitigation together with relief and rehabilitation. As part of the new strategy, The Office of Disaster Management is working with the Department of Education to integrate disaster training into school curriculum.

3.6. RESEARCH

PNG has a national university and two quasi-governmental research institutes – the Institute of Medical Research headquartered in Goroka and the National Research Institute headquartered in Port Moresby. These three institutions oversee a significant proportion of the child-related research conducted in the country.

Basic Research

The Institute of Medical Research, in co-operation with AusAID, is implementing two vaccine development projects – one for malaria and one for pigbel. vii

Operations Research

The Institute of Medical Research is also pursuing operations research that relates closely to the Agenda for Children, e.g. HIV-AIDS; pneumonia; diarrhoeal diseases; malaria; and nutrition. Other research planned for the 2000-2001 that relates to global and/or domestic issues affecting children includes:

 A survey of child labour to be conducted by the Department of Labour in co-operation with UNICEF, ILO);  Investigation into the prevalence of child abuse and sexual exploitation to be conducted by the Child Welfare Council, Department of Home Affairs, Institute of Medical Research, and UNICEF;  A review of potentially harmful traditional practices impacting on children and women;  An investigation of parental knowledge, attitudes, and practices relating to care of sick children (Department of Health, WHO, UNICEF).

3.7. INTERNATIONAL CO-OPERATION

Overseas Development Assistance (ODA) plays an important role in PNG’s development. As a result of growing investor confidence in government’s commitment to reform, ODA has doubled since 1998 and now represents approximately one-third of total government revenue.viii ODA is comprised of:

 Australian budgetary support, a legacy of the colonial era now being phased-out in favour of project aid;  Bilateral and multilateral project aid; (AusAID, European Union, New Zealand, Japan, Germany and others);  Concessionaire loans from international monetary institutions (World Bank, IMF, and ADB);  Technical assistance (United Nations and regional development agencies).

AusAID is PNG’s largest bilateral development partner with assistance in excess of A$100 million per annum (2000-2003 aide memoir). Under the aide memoir, 25% of AusAID project money is to be allocated for health and 25% is to be allocated for education. From 1999 onward, AusAID will channel a portion of its health allocation through a “sector-wide investment modality” - the Health Services Support Project.

Several U. N. organisations maintain offices in PNG. These are UNDP; UNFPA; UNICEF and WHO. ILO, FAO, UNHCR and UNESCO serve PNG from offices located elsewhere in the Pacific Region. In past years, the U. N. agencies have worked semi-independently. Now, in response to U. N. reform, the agencies are coming together under a “Common Development Assistance Framework.” As a first step toward UNDAF, the agencies have established “thematic groups” to co-ordinate U. N. input toward gender, population, and HIV-AIDS. The agencies, in co-operation with the DNPM will undertake a Common Country Assessment in 2001.

28 End Decade Report, Papua New Guinea

4.1. CONVENTION ON THE RIGHTS OF THE CHILD (CRC)

PNG ratified the CRC in 1993, prepared the initial implementation report in 1999, and submitted the report to the United Nations in 2000, (refer to Section I).

4.2. CHILDREN’S HEALTH

General

During the mid-1990s child health initiatives centred around the Child Survival Crash Programme which aimed to strengthen immunisation as the “cutting edge” for a full range of maternal and child health services. As previously noted, the programme enjoyed short-term localised success but failed to achieve long-term improvements in immunisation or other health indicators (Section I). Beginning in 1997, health services were restructured and a new health plan has recently been promulgated for the 2001-2010 period; children’s issues are integrated within this plan (Inset #5).

Water Supply and Sanitation

Water – its availability, quality, reliability – is a major development issue. Only 25-30% of the population utilise protected, drought-resistant water sources. Many households still walk long distances to obtain water. On the average, households spend 44 minutes per day carrying water although in the highlands, it is not uncommon for households to spend up to two hours per day carrying water.ix

While many government plans and policies have aimed to improve access to safe water, government’s efforts have been under-resourced and undermined by technical and cultural factors (e.g. land disputes). The 2000 Health plan proposes two strategies to overcome these problems: (1) improved inter-sectoral co- ordination at local levels and (2) empowerment of communities to assume responsibility for their own water supply. A National Water Board co-ordinates sector input. Although the Board’s mandate encompasses both urban and rural water, the Department of Health is the lead agency for most rural water activities.

83% of households use some type of toilet, generally unimproved pits. Rural sanitation is primarily the responsibility of the Department of Health. The immediate focus is to ensure universal coverage with toilet facilities of some type while gradually intensifying effort to promote improved technologies.

HIV-AIDS

PNG’s initial response to AIDS dates back to 1987, the same year the first case was diagnosed. Efforts have intensified since 1997 with creation of a National AIDS Council and approval of the medium-term AIDS plan (1998-2002). The plan sets out a five—point HIV-AIDS strategy:

 Improved sexual health with emphasis on preventing and controlling transmission of STDs and HIV;  Reduced HIV-AIDS impact through treatment, care, and support services;  Creation of a supportive legal and ethical environment which upholds the human rights of persons infected with or affected by HIV-AIDS;  Mitigation of negative social and economic consequences of the HIV-AIDS epidemic; and  Strengthen national response capacity.

Provincial AIDS Committees have been established. They are responsible for preparing and implementing provincial AIDS plans. In support of the medium- term plan, AusAID has pledged A$65 million for the period 2000-2005. Other donors will augment AusAID’s contribution. For example, UNICEF will support a project aimed at preventing mother-to-child transmission.

30 Inset #5: National Health Plan (2001-2010) GOALS RELATED TO THE GLOBAL AGENDA FOR CHILDREN

Health Promotion aims to empower individuals, families and communities to improve their own health. End Decade Report, Papua New Guinea  Targets:  Provincial partnerships in support of the Health Islands Settings Approach (2002).  Human resource development for health promotion (2004)  Qualitative research in support of health promotion for priority issues (2005) Disease Control gives priority to combating HIV-AIDS, STDs, tuberculosis, and diarrhoeal diseases.  Targets:  Universal screening of all donated blood for HIV (current is 98%) (2002)  Build capacity for syndromic management and antenatal HIV/VDRL screening (2005)  Increase public awareness of HIV-AIDs and STDs  Increase TB treatment completion rates from 38% to 70% (2010)  Expand the Directly Observed Treatment programme to all provinces (2005)  Reduce pneumonia deaths among children under the age of 5 from 16.2 to 6/100,000 (2010)  Reduce diarrhoeal deaths among children under the age of 5 from 10.8 to 5/100,000 (2010)  Reduce incidence of diarrhoea among children under 5 from 1,610 to 1,200/100,000  Expand use of ORT (2002)  Reduce typhoid deaths from 2.9% to 1% of all deaths (2010)  Maintain polio, cholera, and dengue free status (ongoing)  Reduce incidence of measles among children under 5 years from 626 to 100/100,000 (2010)  Reduce prevalence of leprosy from 1.6 to 1 per 10,000 persons (2005)  Reduce malaria deaths from 12.9 to 6.5 per 100,000 persons (2010); reduce malaria incidence from 664 to 330 per 100,00 (2010)  Expand mass drug administration in filaria endemic areas and integrated vector control (2005) Lifestyle Disease control aims to reduce diabetes, heart diseases and cancers.  Targets  Reduce prevalence of diabetes, coronary heart disease, obesity (2010)  Increase the prevalence of daily exercise among all age groups (2010)  Increase early detection of cervical cancer, oral cancer, and breast cancer (2010)  Reduce the prevalence of smoking (2010) Public Health Laboratory services will be strengthened. Family Health promote immunisation, nutrition, treatment of children’s illness and prevent child abuse  Targets  Reduce infant mortality to 53/1,000 and child mortality to 18 (2010)  Increase infant immunisation coverage to 90% and school immunisation to 100% (2010)  Reduce maternal mortality to 260/100,000 live births (2010)  Increase antenatal coverage to 90% and supervised deliveries to 70% (2010)  Increase pregnant women protected by tetanus toxoid to 85% (2010)  Increase use of modern contraceptives to 20% (2010)  Reduce malnutrition among children31 under 5 to 21% (2010)  Reduce iron deficient anaemia among pregnant women to 30% (2010)  Eliminate iodine deficiency disorders (2010) Environmental Health will aim to increase access to safe water and sanitation  Targets  Access to safe water in rural communities will increase from 30% to 50% (2010)  All high schools, hospitals and health centres will have drought-proof water supplies (2010)  Access to safe human waste disposal systems will be increased to 50% (2010) End Decade Report, Papua New Guinea

4.3. NUTRITION INITIATIVES

Under-nutrition is common. Children are affected by protein-energy malnutrition and nutritional anaemia. Anaemia is common among women, both pregnant and non-pregnant. Highland women are also affected by protein-energy malnutrition as a result of frequent child-bearing and heavy physical workloads.

Iodine Deficiency

Prior to 1970, iodine deficiency was prevalent but it was virtually eradicated in the 1970s by mass campaigns using iodine-oil injections. Recently, it has reappeared. Although legislation now requires all salt to be iodised, research suggests that some households do not consume sufficient salt to achieve recommended intake. The Department of Health has recently completed an iodine survey in two provinces; results will be available in 2001.

Vitamin A Deficiency

Despite PNG’s poor health indicators, no comprehensive Vitamin A survey has been conducted. A small survey in the mid-1990s among hospitalised children found a low prevalence of clinical deficiency. This

INSET # 6: COMMON CAUSES OF CHILDHOOD MALNUTRITION

 Complementary Foods: Universal and prolonged breastfeeding is one of the most important child survival practices in PNG today. The benefit of breastfeeding may be undermined, however, by improper use of complementary foods. Early introduction of complementary foods is common; 43% of infants receive complementary feeding during the first 1-3 months of life). Late introduction of complementary foods is also a problem in some areas.  Frequency of Feeding: Although very young infants are breastfed on demand, once solids are introduced, the child may be fed only once or twice a day rather than the recommended 4-6 feeds.  Poor Quality Foods: Starchy staples or thin soups are common traditional infant foods. The soups provide little nutrition while staples are too bulky for infants and young children to meet their energy requirements.  Infection: Illness is common among young children. Children may or may not be fed during illness but their food intake is seldom increased32 after an illness to enable their body to “make up on lost nutrition. End Decade Report, Papua New Guinea

prompted the Department of Health to promulgate a conservative policy on supplementation. Vitamin A tablets are only authorised for use in a limited range clinical conditions (including measles). Recently though the Department has expressed interest in undertaking a more representative serum survey as a basis for future policy.

Food Security

Changes in diet and lifestyle contribute to increasing prevalence of obesity and associated non-communicable diseases especially in urban settings.

Dietary change is documented by food balance comparisons. While food available per capita has increased (from 1756 kcal per person per year in 1965 to 2269 kcal in 1995), the increase results from increasing reliance on food imports, especially rice and other grains. Gains in domestic food production (estimated at 1.7% per annum) are not keeping pace with population growth (2.4% per annum). This has led FAO to classify PNG as a “food deficit country.”x The 1996 Poverty Survey also found poverty and employment in agriculture to be closely associated. 62% of poor households draw their primary livelihood from agriculture.xi

To address food and nutrition problems, government promulgated a National Nutrition Policy (1978 and 1995) and a National Food Security Policy (2000). The 1995 Nutrition Policy calls for (1) improved co-ordination and co-operation for nutrition improvement on the part of the Departments of Health, Education, Agriculture and Home Affairs and (2) localised interventions mounted at district levels in response to localised situation analyses. This same approach is reflected in the 2000 Health Plan. The Food Security Policy calls for an increased focus on food production by subsistence farmers and small- holders and a balanced promotion of cash crops and food crops by a revitalised agriculture extension service.

4.3. WOMEN AND GIRLS

Among the many diverse cultures of PNG, there are those which are matrilineal and/or matriarchal in which women enjoy high social status and little or no discrimination. These, however, are exceptional. Most cultures are patrilineal and exhibit strong gender bias. This is reflected in social indicators, particularly the high maternal mortality rate (Annex C).

Despite deeply ingrained gender bias, the PNG Constitution (1975) is highly progressive in terms of human rights in general and women’s rights in particular. Efforts to establish an institutional structure to ensure equitable development predate independence.

“ We declare our second goal is for all citizens to have an equal opportunity to participate in and benefit from the development of our country.”

And furthermore….

“ … equal participation by women citizens in all political, economic, social and religious activities.” PNG Constitution (1975)

The PNG women’s “agenda” is summarized in the “Platform for Action” prepared for the 1995 International Conference in Beijing. This platform identified actions for women’s advancement in 10 strategic areas with four areas designated for priority attention: (1) strengthening women’s national machinery; (2) economic empowerment; (3) decision-making and good governance; and (4) integration of gender issues into government planning and administration.

A 2000 review of the Platform for Action concluded that living standards for the majority of women had deteriorated as a result of economic and political crises, economic restructuring, and globalisation. Progress was noted however, in terms of the four priority areas: (1) women’s machinery has been enhanced by a revitalised Inter-Agency Women’s Advisory Committee; (2) a National Women’s Credit Scheme has been successfully launched by GoPNG and the World Bank; (3) there are more women in politics, particularly at ward and local government levels; and (4) a Gender and Development Unit within the DNPM is actively pursuing a strategy of gender mainstreaming.xii

Institutional progress is not yet reflected in cultural attitudes, health and nutrition indicators. Education indicators show more girls to be entering school although dropout rates continue to be unacceptably high.

4.4. PARENTING

The CRC Report addresses parenting in considerable detail. Among the concerns:

 The challenge of parenting in a rapidly changing social and cultural environment where institutions and norms of the past are breaking down without being replaced by comparable contemporary structures;  Absence of culturally appropriate guidelines, information, and support for parents and youth soon to become parents;  Widespread “custom adoption” which deprives children of regular contact and nurture from their birth parents but often without providing equitable access to nurture and material resources in their adoptive households;  An inadequate legislative framework to protect children’s rights;  Inadequate social services for children and families with special needs (e.g. disabled; AIDS victims; orphans; children in custody disputes; children who are abused, neglected or exploited, and children in conflict with the law).

Resulting from the CRC report are several initiatives to address children’s needs for nurture and protection.

 Research into the situation of children in especially difficult circumstances;  Research into the prevalence of and underlying causal factors for child abuse or neglect;  Research into the situation of working children;  Law reform spearheaded by the Department of the Attorney General and the Child Welfare Council;  Integration of the Early Childhood Care and Development (ECED) concept into existing health and education networks.xiii

4.5. EDUCATION INITIATIVES

Formal Education: Government’s programme of Education Reform has been previously referenced. The long-term vision of reform is “a national education system resourced and supported by partnerships of all stakeholders at all levels and which produces literate, educated and skilled citizens prepared for development and challenge” (MOE, 1999). Explicit in the reform programme is the goal of universal primary education that is both relevant and affordable.

The reform programme is comprised of four sub-programmes: (1) the Education Access and Expansion Programme responsible for reforming the institutional structure of the education system; (2) Relevant Education for All Programme responsible for pedagogical reform; (3) the Literacy and Information Programme which addresses non-formal education; and (4) the Higher Education programme which addresses vocational, technical, and professional skill requirements. Gender equity is a cross-cutting theme running through each of the programmes.

The reformed education structure comprise of: (1) three years of village-based elementary schooling (Preparatory, Grades 1 and 2) in the vernacular; (2) six years of primary education in English; (3) two years of lower secondary schooling or alternately of vocational training; and (4) two years of upper secondary. Tertiary education consists of colleges, universities, and technical training institutions.

The programme has successfully expanded access to basic elementary education as evidenced by a 50% increase in gross enrolment (1991-97). It has not, however, overcome gender inequities or achieved retention goals. Many factors contribute to the programme’s initial success: (1) strong and consistent support by successive governments throughout the 1990’s; (2) strong and consistent support by overseas development partners; (3) involvement of communities and parents in many aspects of the reform programme including as members of School Boards of Management; and (4) development of a system of co-ordination, monitoring and surveillance through the Facilitating and Monitoring Unit of the Department of Education.

Literacy: While churches and non-government organisations have long been the backbone of literacy programmes, their efforts have been localised and often under-resourced. Government, while recognising a need for literacy development, has been unable to provide adequate leadership or funding. Literacy activities receive 1% of government’s education kina.

Over the years, a major stumbling block has been discord on the issue of language – English, pidgin or motu, or the vernacular. With elementary education now offered in the vernacular, this issue may have been resolved. The National Literacy Policy adopted in 2000, evades the issue of language, but implicit in the policy is a preference for vernacular based programming. Although resources remain scarce, with 14,000 elementary teachers eventually to be deployed in virtually every village of the country, it is reasonable to hope that in due course these teachers can be mobilised as adult literacy workers in addition to their roles as early childhood educators.

Vocational Training: Vocational education has long been a neglected area. There are 115 vocational centres, most in rural areas and most operated by churches (1999). While originally created for grade 6 leavers, entry now favours grade 8 and grade 10 leavers. The existing system of vocational centres suffers from many weaknesses which undermine the competencies and employment prospects of graduates.

To address these problems, a Vocational Training Policy was recently introduced. Under the policy a National Training Authority is created to oversee training, apprenticeships, testing and technical education. In support of the policy, the German Government has made a long-term resource commitment (1998-2010). German support is geared toward improving training standards and living conditions, increasing female participation, and strengthening entrepreneurial skills training in order to prepare graduates for rural self-employment. AusAID, as well as other donors, will provide additional inputs into vocational and technical training.

4.6 CHILDREN IN DIFFICULT CIRCUMSTANCES

The CRC Report argues convincingly that there are a substantial number of children living in difficult circumstances. As previously noted, this is a relatively new concept for many people who heretofore have assumed that traditional family systems meet the needs of all but a small number of marginalised children.

Because the concept of children in need is new and has not yet been defined in terms of Melanesian cultural realities, there is little data to show the number of children affected or the underlying causes of their situation. Operational research is then a critical first step toward securing their rights.

Drugs and Alcohol: Although sale of alcohol to persons under the age of 18 is prohibited, as is possession, or cultivation of marijuana, use of these substances by older children and youth is widespread although there are few definitive statistics on incidence or prevalence. Alcohol use, especially “home brew” is closely associated with crime while marijuana use is closely associated with mental illness (marijuana induced psychosis).

The National Narcotics Bureau, in co-operation with the Departments of Health, Education, and Home Affairs, provides education on the dangers of drugs and alcohol. The issue, however, has not been accorded high priority given the many pressing needs competing for the same resources.

Tobacco: Tobacco is locally grown and smoking is prevalent. As part of the global “Tobacco Free” movement spearheaded by WHO, PNG has enacted smoking control measures and initiated anti-tobacco education that targets children and youth.

4.7. WAR AND VIOLENCE

VIOLENCE

Violence is an integral part of contemporary life in PNG. Within the family, violence against women is common. While overt violence against children is generally believed to be less common, many parents use heavy physical discipline which may cross the border into physical abuse.

Inter-family and inter-clan warfare is common, particularly in rural areas. In urban areas, “raskolism” is a major impediment to women and children realising their rights. (Note: “Raskols” are young people, generally male, often unemployed, who roam the streets engaging in apparently senseless acts of vandalism, thievery and violence. Murder and rape at the hands of raskols is all too common in urban communities. Police are generally ineffectual in protecting the public or in bringing perpetrators to justice).

:…most children in PNG are now growing up in situations where the use of violence, often extreme, by family, community and the state is common. Violence in one form or another has become increasingly normalised and accepted as a part of PNG life and society.”

Save the Children Fund Country Strategy Paper, 1996, page 5.

The immediate causes of violence – cultural acceptance of violence, family breakdown, social change, unemployment – are in turn linked to the wider social and economic development status of the country. At the same time, violence impedes development. Despite hundreds or even thousands of meetings, conferences, studies, and projects over the past decade, no one has yet devised an effective and sustainable solution to the problem.

REFUGEES

As of 1998, there were 3,789 Iran Jaya refugees residing in an official government-run refugee camp in the western part of the country. 55% of these were children under the age of 18 years. A further 6,000 “unofficial” refugees live alongside the border. In the official camp, the Catholic Church and the government provide health and education services equivalent to or superior to that available to PNG citizens residing in the same area. The “unofficial” refugees receive no government services and only sporadic church services; the situation of these “unofficial” children has not been assessed.

The long-term future of the refugees is uncertain. Since tensions in Irian Jaya began (as far back as the 1960’s) a large number of refugees have been assimilated into PNG society and in some cases have been granted citizenship. xiv Today, the situation is in a state of flux. Tensions are mounting as the Iran Jaya independence movement gains momentum. New refugees – predominately women and children – are crossing the border although exact numbers are not known. To address the many complex issues involving the refugees, UNHCR will establish a permanent “presence” in PNG early in 2001.

VICTIMS OF ARMED CONFLICT

After eleven years of civil war, an uneasy peace has returned to Bougainville (the North Solomons Province) although a formal peace agreement between GoPNG and provincial authorities is has not yet signed. GoPNG has formed an inter-sectoral task force to plan for the eventual restoration of services immediately following formalisation of the accord. In the interim, GoPNG has only a limited “presence” on the island. International assistance agencies are present. Over time, their efforts have shifted from emergency to developmental operations.

No comprehensive situation analysis of children in Bougainville has been undertaken although UNICEF plans to conducted a rapid appraisal in 2001. Preliminary assessments suggest that health needs are relatively well catered for by local and international initiatives. There are, however, massive needs for education, HIV-AIDS prevention and mitigation, and social reintegration.

4.8. THE NATURAL ENVIRONMENT

The PNG Constitution accords high priority to sustainable development and conservation. It was on this basis that a national environmental policy was initially formulated in 1976. PNG is a signatory to the “Rio Declaration” and “Agenda 21” (1992) and has ratified most of the subsequent international environmental conventions including those on climate change and bio-diversity. A regulatory system to assess and mitigate the environmental impact of major projects is in place through the Department (now Office) of Environment and Conservation.

Legislation is pending to consolidate many of PNG’s environmental laws under one umbrella and to introduce a new protection strategy based on watershed management. However, with the economy dependent on non-renewable resources, this approach is controversial. In preparation for the Earth Summit follow-up (2002), Government (in co-operation with the United Nations) will begin assessing progress and future directions from 2001 onward.

4.9. POVERTY, DEBT, AND RESOURCES FOR CHILDREN

Debt repayments represent a significant drain on government’s resources (Figure X), at the same time that new concessionaire loans are an importance source of capital infusion. While debt has been a factor in the economic crises of the 1990s, debt and under-financing of the development agenda are less important constraints on achieving Global Goals for Children today than is lack of institutional and human resources capacities to undertake all the work still outstanding.

Figure 2: PNG Govenme nt Expe nditures: % By Category 1998-2000

Debt Service

Local Govt.

Economic Dev.

Social Dev.

Administration

0% 5% 10% 15% 20% 25% 30% 35% 40%

POVERTY

The World Bank conducted a nation-wide household poverty survey in 1996. Investigators proposed an average national poverty line of K461 per adult equivalent (based on the cost of food plus a small multipler for other cash expenditures). Because prices vary among the different regions, separate poverty lines were calculated for each of the five regions. These ranged from K1016 in the National Capital District to K280 in Momase (North Coast).

37% of PNG households were found to be impoverished. 93% of the poor live in rural areas. Although the highest poverty rate was found in Momase (where 46% of households were poor), the largest number of poor people live in the Highlands Region. The National Capital District (Port Moresby and environs) has both the lowest prevalence of poverty and the lowest number of people living in poverty. Households whose principal livelihood derives from subsistence agriculture or tree-crop production were more likely to be poor than households with other income sources. Poverty was also more common in households headed by older persons and persons without schooling. Poor households have much lower access to basic infrastructure (transportation, schools, and health centres) than non-poor households. For example poor household walk an average of 90 minutes to the closest mode of transport (road, airport or port) while non-poor households walk a average of 55 minutes. xv Investment in basic infrastructure is then an important component of a comprehensive poverty alleviation strategy.

5.1. LESSONS LEARNED

In this section some of the lessons which have evolved out of the CRC and End Decade reporting processes will be highlighted. The initial section will focus on cross-sector lessons. Subsequent sections will address sector-specific lessons as identified during parallel review activities in health, education, and women in development.

5.1.1. GENERAL LESSONS

Political commitment - ESSENTIAL BUT NOT SUFFICIENT

High level political commitment is essential for any substantive action in PNG. Effectively, this means endorsement of any proposed policies or programmes by the National Executive Committee. However, political commitment, even at the highest level, is not sufficient to generate change especially change in the lives of the rural majority. Change requires: -

 Sustained commitment by proponents;  Mobilisation at all levels (national, provincial, district, and local);  Formation of strategic alliances and broad-based partnerships.

Government initiative – Important but also not sufficient

As elsewhere in the Pacific Islands region, it is a legacy of colonialism that government is a major force for development in virtually every field of endeavour. However, government initiative alone is an insufficient catalyst for sustained social change. Change requires not only changes in government structures, procedures, and services but fundamental changes in the differing “world views” of 860 distinct cultural groups. This is a long-term process that can take place only as a result of broad-based social mobilisation.

 Despite language, literacy, and geographic limitations, the media has an important role to play in informing and shaping the opinions of decision-makers. The media is increasingly active on children’s issues; this must be encouraged and supported.  NGOs are providing essential services for women and children often in geographic areas that government reaches only sporadically or in fields of service for which government has few resources (e.g. literacy and social welfare). NGOs, however, under-resourced. There is an urgent need for NGOs to be 44 End Decade Report, Papua New Guinea

assisted through institutional capacity building which also addresses long-term strategies for achieving financial sustainability, at least sufficient to meet recurrent operating costs.  Community-based organisations are a tremendous resource for social change heretofore not fully tapped in support of child-centred programmes. If substantial progress is going to be made to mould people’s opinions on such sensitive matters as rights, parenting, discipline, and reproductive health, community-based organisations will have to be at the forefront of these initiatives.

One of the most important lessons to emerge from the Child Survival Crash Programme is that '‘social mobilisation’ works.

UNICEF-PNG Mid-Term Review

COMMUNITY OWNERSHIP-

Ultimately, communities themselves must assume responsibility for the well-being of their own children. Government and other service networks simply do not have the resources to provide more than supportive services for communities’ own initiatives.

 Sustainable development, especially with respect to family life and childrearing, ultimately requires that initiatives be owned by families and communities.  Ownership, however, is not simply a function of participation; it is also a function of responsibility and accountability over resource allocations.  Ownership requires that families and communities be assisted to assess their own needs and plan their own programmes and that their informed choices are respected by professional service providers.  Community ownership requires a fundamental re-orientation of the roles and attitudes of community workers – both government and non-governmental. In the past, community workers have acted while communities have advised; this relationship must be reversed in the future.

Ownership of ‘children first’ initiatives

While technical, structural, and resource limitations have been factors in PNG’s generally low levels of progress toward Global Goals for Children, a more fundamental issue has been one of ownership. High level commitment was given a decade ago to the World Summit Declaration, the Global Goals, and the CRC but there was no real domestic ownership to ensure that these documents were effectively used as agents for change.

Ownership is now emerging but among a small group of urban elites. Their challenge will be to interpret the “New Global Agenda for Children” in a manner that is meaningful to ordinary citizens and then to foster ownership at every level of society.

 The “New Global Agenda for Children” must be embraced, adapted, owned, and used by children and their proponents in the domestic context.  Ultimately, the “New Global Agenda” must own themselves.

Focal point

Both the CRC and End Decade Reporting processes have demonstrated the importance of a focal group to take responsibility for co-ordinating initiatives that address the “whole child.” As a practical matter, such a focal group will be Moresby-based and dominated by urban elites. This constraint, however, can be mitigated by the formation of alliances with local governments and community-based organisations.  An intersectoral focal group for children must be identified; such a group will ideally reflect an equitable tripartite alliance between government, non- government organisations, and community based organisations.  The focal group must design and implement a participatory planning and monitoring process that will provide a mechanism for co-ordination, co- operation, and alliance formation.  Because resources are limited, an efficient organisational structure must be designed which makes use (to the extent possible) of existing personnel and structures.

Planning and monitoring

The lack of an integrated plan for the 1990’s was ultimately a constraint to achieving decade goals.

 A National Plan of Action which addresses the “New Global Agenda” as well as domestic issues will be important for the securing the rights of children over the coming decade.  The plan must be supported by an effective monitoring system that combines into a holistic framework information derived from routine reporting, surveys, sentinel surveillance sites, and operations research.

5.1.2. SECTOR SPECIFIC LESSONS

EDUCATIONXVI

As part of a global process to review the Education For All Initiative, PNG undertook an extensive review of its education reform programme in 1999. The findings relevant in the context of the World Summit goals are summarised in the paragraphs following. 46 End Decade Report, Papua New Guinea

Education reform is working. A larger number of children are entering school, staying longer and achieving more than pre-reform. Despite initial success, the programme is still not fully operational in all areas of the country; there are many issues that require further attention

 At all levels…  The working conditions of teachers must be reviewed and positive steps taken to attract suitable people for training and to retain effective teachers in the teaching service.  Salary levels, especially for elementary teachers are low; this may ultimately pose a restraint to recruitment. However, if reforms are to be financially sustainable with domestic resources, salaries must be contained. This is a paradox the resolution of which will significantly influence the long-term viability of the programme.  The quality of learning must be continuously monitored.  A relevant curricula suitable to a range of cultural and economic contexts must be developed and continuously monitored to ensure ongoing relevance.  Adequate funding must be allocated to support the programme; because start-up costs are high, continued donor support is essential.  The programme must incorporate long-term and systematic community awareness raising about the intrinsic value of education irrespective of whether education leads to wage employment.  Because implementation for the next 5-10 years will exceed government’s resources, it is important that efficiency be emphasised. Even small changes in the programme design can result in significant cost increases that will undermine long-term sustainability when donor funds are withdrawn. Essential for efficiency are (1) co-ordinated planning and implementation, (2) efficient teacher deployment and (3) community involvement.  Provincial and district officials responsible for planning (education planners and planning committee members) need to have further skills in planning (with emphasis on costing and scheduling).  School-to-work strategies must be integrated at every level of the system.

 Within elementary education there is need to….  Develop effective teacher training models for elementary teachers.  Identify strategies to successfully engage communities, parents, and teacher curricula development.  Because professional educators do not universally embrace the concept of community participation and responsibility for school management, educators need training, support, and where necessary, supervision to ensure that the community based philosophy of reform is universally respected.  Identify strategies to reduce the number of students who ‘drop-out’ especially those who leave school prior to grade 3.  Identify strategies to address the special needs of girl students as a basis for eventually eliminating gender bias.

 Within primary education there is need to…  Empower teachers in grades 3 and 4 to help students make the transition from the vernacular into English. 47 End Decade Report, Papua New Guinea

 Upgrade the knowledge and skill levels of grade 7 and 8 teachers.

 Within secondary education there is need to…..  Develop alternative curricula for the increasingly wide range of abilities among students who choose to remain in school.  Re-skill teachers to take greater responsibility for curricula development which draws on local resources and addresses local needs.  Within life-skills education there is need to…  Recognise the importance of life skills education;  Provide innovative and flexible post-school institutions which are sensitive to the needs of out-of-school students.

Educators recognise a growing negativity to education by parents and communities who hold unrealistic expectations about the link between education and wage employment. Department of Education 1999

 Within non-formal education there is need to…  Provide adequate funding to address the unacceptably high rates of illiteracy;  Develop partnerships between the Department of Education, non-formal educators, and other community groups to ensure that opportunities for non- formal education are widely available and accessible to the majority of rural people;  Mobilise communities to meet their own literacy needs;  Go beyond “basic” literacy to build actual fluency. To retain fluency, it will be necessary to substantially increase production of reading materials in the vernacular.

HEALTHXVII

In 1998, the Department of Health organised a participatory review of the 1995-2000 Health Plan. It found that progress toward most goals was generally unsatisfactory. From the review, it was learned: 48 End Decade Report, Papua New Guinea

 Enthusiasm, commitment, resources, and energy will not achieve sustained health improvements if the instructional structure for health is inadequate.  Greater efforts must be made to effectively mobilise community-based organisations in support of health improvement.  Communities themselves must assume greater ownership of and responsibility for health development.

WOMENXVIII

In the absence of an effective institutional structure for women’s programming, progress toward achieving the 1995 Platform for Action has been slow.

 An effective organisation structure is essential for forward progress.  Clear achievable targets are needed.  Policy and resource commitments are needed at the highest political levels.

5.2. FUTURE DIRECTIONS

PLANNING

The process of preparing the NPA will be the focus of work in the initial months of 2001. This planning process will be used to strengthen and expand the “Alliance for Children.” This will require a broad-based initiative entailing institutional capacity building, advocacy, social mobilisation, and monitoring. The planning process should…

 Encourage active participation by a cross-section of society;  Link with planning processes in progress at sub-national levels;  Contribute toward and draw from the “New Global Agenda for Children.”

INSTITUTIONAL STRUCTURE

The official focal body for children is the Inter-agency Working Group chaired by the DNPM. However, this body is comprised only of government representatives and at present has a weak operating structure that does not facilitate sustained action. There is need to:

 Identify strategies for expanding membership in the Working Group to include representation from civil society; 49 End Decade Report, Papua New Guinea

 Develop linkages to the planning system in progress at provincial and district levels;  Strengthen and formalise operating procedures to support more sustained effort, (e.g. regular meetings, clearly defined agendas, secretariat support, systematic follow-up on decisions.)

Over the medium-term the roles and responsibilities of the Inter-Agency Working Group and the DNMP will be influenced by a decision now pending before Parliament on the proposed PNG Human Rights Commission. If parliament approves the proposed Commission, after an initial period of organisation and capacity-building, there will need to be rationalisation of functions between the Child Rights Desk within the Commission and the Inter-Agency Working Group on Children within DNPM.

A Holistic Focus

While highest priority will continue to be given to health and education, it will be necessary to broaden the focus of the national “Agenda for Action” to consider all of the rights set forth in the CRC. Special consideration will also be needed for:

 Monitoring and surveillance mechanisms that support and expand on work already in progress by DNPM (“Child Info), Health (routine health information system, IMCI and Multi-Indicator Cluster Surveys), Home Affairs (civil registration) and Education (routine education information system  Law reform which must also support and build from work already initiated (see section following);  Administrative reform especially in social welfare and juvenile justice;  Child protection and the closely related issue of “custom” adoption;  Special needs of children in difficult circumstances.  Mobilisation of resources for children especially in the broad area of social welfare where there is little money currently allocated.

As a part of the planning process, the Interagency Working Group will need also to identify strategies for:

 Advocacy;  Alliance creation especially with churches and other community-based organisations.

Law Reform

While some twenty pieces of legislation have been identified for eventual amendment in line with the CRC, short-term priorities have already been identified. Work is co-ordinated by the Department of the Attorney General in co-operation with:

 The Department of Home Affairs and the Child Welfare Council (amendments to the Child Welfare Act);  The (ad hoc) Parliamentary Working Committee on Children (amendments to the criminal code that address child abuse, sexual assault, and prostitution).  The Department of Labour (development of new child labour legislation).

Health Initiatives

The Department of Health has already promulgated the National Health Plan, 2001-2010. Children’s needs are well reflected in this document. The priority now is to ensure broad-based commitment to the plan leading toward its systematic implementation and monitoring. Between the Department of Health and the Inter-Agency Working Group, there will need to be close inter-exchange in the areas of alliance creation, social mobilisation, and outreach to community- based organisations.

The provisions of the health plan are augmented by the Medium-Term AIDS Plan (1998-2002). Issues of mother-child transmission, the special needs of children affected by HIV, and mobilisation of children and youth for prevention are key areas of convergence between the national AIDS agenda and the national children’s agenda.

Education Initiatives

The programme of education reform embraced by the PNG government has already been described. Full implementation may extend over the whole of the coming decade. It is important that there be sustained efforts in the context of a stable policy. Because reform depends heavily on external funding, ‘donor fatigue’ must be avoided at all costs. IN addition to the current four-part reform programme described in Section IV, the Department of Education has prepared three additional projects for which donor assistance is being sought. These are:

 Curriculum Reform Implementation Project;  Community Equity in Education Project (the focus of which is achieving gender equality in education); and  Support Project for Skill Training which will strengthen institutional supports for school-to-work initiatives (at all levels) and vocational and technical training.

Literacy

At present, there is a policy on literacy but no programme of action. The Department of Education needs to develop such a plan in close consultation with churches, NGOs, and community-based organisations that are the actual providers of literacy services. The national policy sets a very ambitious objective of

achieving 70% adult literacy by 2010. Achieving this target will require a major “Literacy Crash Programme” supported by substantial infusion of new financial resources. In the current environment, such resources can only come from overseas development assistance.

Early Childhood Care and Development

The concepts of early childhood care and development have been proposed for integration into the health and education networks as a first step toward addressing the parenting issues identified in the CRC Report. Beyond support for parents, there are also issues to be addressed in relation to community based pre-schools (“tok ples” pre-schools) and child care options for working parents in urban areas.

The Department of Education has initiated preliminary research into alternative models of ECCD that will eventually support policy formulation. In the interim, Goroka University has recently announced that it will introduce early childhood training as part of its curricula. This is a strategically important initiative that marks that University as a key partner in the Alliance for Children. Other institutions must be encouraged to learn from and build on the Goroka initiative.

Other Government Initiatives

The University of Papua New Guinea (UPNG) is a new participant in the PNG Alliance for Children. The University has taken the initiative to organise two seminars in Port Moresby (Leadership Forum and Youth Forum); the outputs of these seminars will support NPA formulation. UPNG is also prepared to work with UNICEF to strengthen its own institutional capacities for rights based training through integration within continuing education (to serve the community) and integration within core degree programmes (to serve tertiary students).

The Institute of Public Administration has recently announced that it will integrate child rights into its programme of in-service training for civil servants. xix A proposal has also been drafted for UNICEF to provide training and institutional capacity building support for the DNPM. This support would aim to strengthen the integration of child rights issues into the national and sub-national planning processes.

The women’s movement is closely linked to the children’s movement through the shared concepts of “rights” as well as the physical, psychological, and social links that exist between the wellbeing of a woman and her children. Women leaders have accorded high priority to strengthening women’s institutional machinery. It is this machinery that will need to respond to PNG’s reporting and monitoring obligations under CEDAW and become a partner in the Alliance for Children.xx

Civil Society

Many NGOs are already working to address children’s needs. This work will be facilitated by participation in and support from the NPA process.

The PNG Media Council is an especially important new member of the PNG Alliance for Children. The efforts of the Council to improve media about children and for children must be encouraged and supported.

Annex C

STATISTICAL ANNEXES

Contents

 GOAL # 1 INFANT AND CHILD MORTALITY A. 1.  GOAL # 2 MATERNAL MORTALITY A. 2.  GOAL # 3 CHILD MALNUTRITION A. 3.  GOAL # 4-5 WATER AND SANITATION A. 4.  GOAL # 6 BASIC EDUCATION A. 6.  GOAL # 7 ADULT LITERACY A. 7.  GOAL # 8 CHILDREN IN DIFFICULT CIRCUMSTANCES A. 8.  GOAL # 9 WOMEN’S HEALTH A. 9.  GOAL #10 CONTRACEPTION A.10.  GOAL #11 OBSTETRICS A.11.  GOAL #12 LOW BIRTH WEIGHT A.12.  GOAL #13 ANAEMIA A.13.  GOAL #14 IODINE DEFICIENCY A.14.  GOAL #15 VITAMIN A DEFICIENCY A.15.  GOAL #16 BREAST-FEEDING A.16.  GOAL #17 GROWTH MONITORING A.17.  GOAL #18 FOOD SECURITY A.18.  GOAL #19-22 IMMUNISATION A.19.  GOAL #23 DIARRHOEAL DISEASES A.23.  GOAL #24 ACUTE RESPIRATORY INFECTIONS A.24.  GOAL #25-27 GUINEA WORM, EARLY CHILDHOOD AND NON-FORMAL EDUCATION A.25. 54 End Decade Report, Papua New Guinea

 GOAL #28 CONVENTION ON THE RIGHTS OF THE CHILD A.28.  GOAL #29 INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS A.29.  OTHER HIV-AIDS A.30.

 REFERENCES

STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA GOAL #1. BETWEEN 1990 AND 2000 REDUCE INFANT AND UNDER-FIVE CHILD MORTALITY BY ONE-THIRD OR TO 50 AND 70 PER 1000 LIVEBIRTHS RESPECTIVELY WHICHEVER IS LESS. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Infant mortality rate 86 1986-90 69 1991-6 N/A Available National DHS ’96, p.79 (Infant deaths per 1,000 livebirths) 2001 Under-five child mortality rate 108 1986-90 93 1991-6 N/A Available National DHS ’96, p.79 (Deaths among children 0-4 years per 2001 1,000 livebirths)

Source of Data: Data are derived from the 1991 and 1996 Demographic and Health Surveys as reported in the 1996 Demographic and Health Survey (DHS), pages 75-85.

Discussion The figures most commonly published for PNG are 82/77 and 133/102 respectively for infant and under-five mortality. These figures, however, refer to a ten-year averaging of data derived from the Demographic and Health Surveys. Five-year averaging of data yields the figures shown in the table above (DHS, 1996, Table 7.3, pages 79-80). These should be considered the best available current estimates for PNG. A third DHS planned for 2001 will generate estimates for the 1997-2001 period.

Disparities There are substantial disparities between the regions of the country as shown in the table following for the ten-year period 1987-1996.

Mortality Estimates by Place of Residence, 1987-1996 (Source: Demographic and Health Survey, 1996. Pages 81-82) National Urban-Rural Region Urban Rural Southern (Papua) Highlands Northern (Momase) Island IMR 77.3 33.7 86.6 41.0 114.0 75.7 49.3 U5MR 100.0 46.0 111.5 66.2 139.0 96.1 66.9

Trends Analysis of mortality data 1971-1996 shows no significant progress toward reduced mortality since 1974.

STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA GOAL #2. BETWEEN 1990 AND 2000, TO REDUCE MATERNAL MORTALITY BY ONE-HALF. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Maternal Mortality Ratio N/A -- 370 1996 est. N/A 2001 data National DHS ’96, p.88-91 (deaths of pregnancy related causes of 1984 pending occurring during pregnancy or delivery mortality or within 42 days after termination of pregnancy)

Source of Data: Data are derived from the 1996 Demographic and Health Survey, pages 88-91.

Discussion In 1996, UNICEF and WHO used regression modeling techniques to derive an estimate of 930 for MMR (circa 1990). In 1996, the National Statistics Office measured maternal mortality for 1984 using the indirect sisterhood method based on the 1996 Demographic and Health Survey. This method derived the MMR figure of 370 shown above. This should be considered the most accurate and most current estimate of MMR for PNG. New data will become available in 2001 from the forthcoming Demographic and Health Survey to estimate MMR 1988.

Disparities There are substantial disparities between the regions of the country. MMR in the highlands is estimated at 625 in comparison to 273 for coastal areas.

Trends Trend analysis is not possible until 2001 data become available. STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA GOAL #3. BETWEEN 1990 AND 2000, TO REDUCE SEVERE AND MODERATE MALNUTRITION AMONG CHILDREN UNDER FIVE BY ONE-HALF. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Underweight prevalence 29.9% rural 1982 33.3% 1996 28.9% 1999 82/86=Rural/ 82/86=FAO,Table (<5’s 2 standard deviations below 13.6% urban 4A; Nat’l Nut. Surv. median weight for age of urban 1986/7 96=National 86=Gibson, p.86-8 NCHS/WHO reference population) 99=National 99=DOH Stunting prevalence 43.2% rural 1982 42.9% 1996 N/A. 82/86=Rural/ 82/86=FAO,Table (<5’s 2 standard deviations below 18.9% urban 4A; Nat’l Nut. Surv. median height for age) urban 1986/7 96=National 86=Gibson, p.86-8 Wasting prevalence 5.5% rural; 1982 8.1% 1996 N/A. 82/86=Rural/ 82/86=FAO,Table (<5’s 2 standard deviations below 4.1% urban 1986/7 urban 4A; Nat’l Nut. Surv. median weight for height) 96=National 86=Gibson, p.86-8

Source of Data: 1982 and 1986/87 data are as reported by FAO (Nutrition Profile for PNG, 1999) based on data derived from the National Nutrition Survey of rural areas (Heywood, P., et.al., 1988) and National Nutrition Survey of urban area (Jenkins, C., and Zemel, B., 1990). It should be noted that Harvard reference points were used for determining cut-off points; not NCHS/WHO reference points as specified in the global guidelines. 1996 data are derived from the Household Survey Component of the 1996 World Bank Poverty Assessment (Gibson, J., and Rozette, S., 1998); NCHS reference points are used for these data.1999 data are derived from the Ministry of Health and refer only to children seen in health clinics. 57 End Decade Report, Papua New Guinea

Discussion The 1982, 1986/7, and 1996 data series are of high quality. 1999 data should not be used for trend analysis or international comparison. Disparities Regional Variations in Child Malnutrition: 1996 World Bank Poverty Assessment (Gibson, J., pp. 86-88) Urban-Rural Regional Variations Urban Rural NCD Southern Highlands Momase Islands Wt-for-Age 19.9% 35.7% Nav. Nav. Nav. Nav. Nav. Stunting Nav. Nav. 20.3% 40.5% 55.8% 38.8% 25.6% Wasting Nav. Nav. 17.5% 7.9% 3.5% 12.2% 6.6%

Trends Comparison between the 1982/87-7 data series and that for 1996 suggests little progress has been made toward malnutrition reduction goals. STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA GOAL #4: UNIVERSAL ACCESS TO SAFE DRINKING WATER. GOAL #5: UNIVERSAL ACCESS TO SANITARY MEANS OF EXCRETA DISPOSAL.. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Population using (1) piped water; (2) 20% 1990 35.6% 1996 41% 1998 National 1990=DOH, p.257 public standpipe/tap; (3) borehole or 1996=Gibson, p.80 pump; (4) protected well or spring; (5) 1998=DOH p.4 rainwater. Population using (1) toilet connected to 10% 1990 82.9% 1996 83% 1998 National 1990=DOH, p.259 sewer or septic system; (2) pour flush 1996=Gibson, p.81 latrine; (3) pit latrine (improved or 1998=DOH p.4 traditional).

Source of Data: 1990 data are derived from estimates of the Department of Health as published in the PNG National Health Plan 1991-95 (pages 257 and 259). 1996 data are derived from the World Bank poverty Assessment (Gibson, J. and Rozelle, S., 1998, pages 80 and 81). Department of Health data for 1996 show water coverage at 24%; the difference is probably due to differing definitions of “coverage.” Data for 1998 are drawn from the “National Inventory of Health Facilities, 1998” as reported in the National Health Plan 2001-2010 (page 4).

Discussion It cannot be verified that the definitions used in calculating PNG data adhere precisely to the international standard. In general, PNG definitions are based on access to “protected” water sources. “Protected sources” included piped water, well water and rainwater but excludes surface water (rivers, lakes, creeks, and springs). The Department of Health’s definition for “safe excreta disposal” in 1990 was probably overly conservative by including only “improved” toilets. Although derived from different sources, 1996 and 1998 data appear to be comparable and include virtually any toilet under the definition of “safe.” Disparities Availability of water within a reasonable distance from the household is a major concern for many rural residents. As a national average, households in PNG expend 44 minutes per day carrying water with households in the Highlands Region expending up to 2 hours per day on this task. Although urban coverage is much higher than rural coverage, urban squatter communities may not have safe or reliable water supplies within the village area. There are wide inter-provincial variations for both water and sanitation coverage. World Bank data show a range for water coverage from 2% (Southern Highlands) to 92% (National Capital District) and for sanitation coverage from 27% (Manus) to 93% (National Capital District). Trends The trend cited above for water is probably an accurate reflection of improvement over the decade although it is unlikely that 1998 coverage has increased to 41%. Because it is probable that the sanitation baseline cited for 1990 understates the actual extent of sanitation coverage, no trend analysis is possible for sanitation. STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA GOAL #6. TO ACHIEVE UNIVERSAL ACCESS TO BASIC EDUCATION AND ACHIEVEMENT OF PRIMARY EDUCATION BY AT LEAST 80% OF PRIMARY SCHOO-AGED CHILDREN WITH EMPHASIS ON REDUCING DISPARITIES BETWEEN GIRLS AND BOYS. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Survival rate 60.2 59.3 1990 68 68 1995 59.6 60.7 1996 National EFA 2000, (children entering grade 1 reaching pp.134-144 grade 6; male-female) Net community school enrolment 36% 1990 54.4 47.7 1996 N/A -- National 1990=Situation (children 8-13 years of age enrolled Analysis 1996 in community school, male-female) 1996=Gibson Gross primary school enrolment rate 54.9 51.7 1990 67.5 64.8 1995 41.8 66.4 1997 National EFA 2000, p.A91. (children enrolled in primary school divided by child population 7-12 yrs) Net primary school attendance N/A -- N/A -- N/A. ------(children of primary school age enrolled in and attending primary school) Proportion entering school 22.54 1988 N/A. N/A. -- National Situation Analysis 59 End Decade Report, Papua New Guinea

(for PNG = 7 year old children 1996, p. 113. entering grade one at age 7) Learning achievement 89.8% 1991 85.3% 1993 N/A. -- National EFA 2000, page (students reaching grade 4 who pass A.153. national competency examination)

Source of Data: Most data are derived from the Ministry of Education’s Education for All 2000 report. The Ministry does not routinely collect data on the age of school enrollees, hence it is not possible to routinely assess net enrolment. Gross enrolment figures, however, are available as shown. Because late school commencement remains a significant problem in the country, net enrollment is likely to be substantially lower than gross enrollment. Net enrollment figures were calculated by Gibson from World Bank poverty data files (see Gibson, S., page 67). Note that PNG’s survival rate is based on survival to grade 6, not the grade 5 specified by global guidelines. Disparities World Bank data files show wide regional variations in net enrollment as shown here for males/females/both sexes: NCD (78.3/73.7/76.0); Southern (53.3/49.2/51.4); Highlands (44.8/43.7/44.3); Momase (60.5/39.3/51.0); Islands (71.8/64.9/68.0). Momase and the Highland Regions are at particular disadvantage. It is also in these regions where the male-female differential is most pronounced.

Trends The PNG education system has undergone substantial reforms in recent years with the aim of achieving universal elementary enrolment (preparatory, grades one and two), universal progression to primary school (grades 3-8), increased progression to secondary school, and improved academic performance. The reformed system of education is being progressively introduced around the country but improvements are not yet reflected in available data. This situation is expected to change over the next five years as the reform program expands nation-wide. STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA GOAL #7: TO REDUCE ADULT ILLITERACY TO AT LEAST ONE-HALF 1990 LEVELS WITH EMPHASIS ON FEMALE LITERACY. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Adults who state they can read and 49.5 40.3 1990 N/A N/A -- National 1990 Census write (male-female) Adults With No Schooling N/A -- 41.5 50.2 1996 N/A -- National DHS 1996, p.22-3. Median Years of Schooling (M/F) N/A -- 2.9 0 1996 N/A -- National DHS 1996, p.22-3. Adults who can read a newspaper N/A -- 63.1 44.4 1996 N/A -- National Gibson, p.71 (male-female)

Source of Data: 1990 data derives from the census of that year. 1996 data on adults with no schooling and median years of schooling is derived from the Demographic and Health Survey, pages 22-23. Data on adults who can read a newspaper is derived from the World Bank poverty assessment data files as reported by Gibson, J. and Rozelle, S., 1998 (page 71). Discussion: Note that World Bank data most closely resembles the international indicator which is “Proportion of the population over the age of 15 able, with understanding, to read and write a simple statement on their everyday life.” Disparities: As for most other indicators, there are wide regional variations with women, especially in the Highlands, at special disadvantage.

Regional Variations in Adult Literacy Indicators by Gender (Male-Famale) National NCD Southern Highlands Momase Islands Male Female Male Female Male Female Male Female Male Female Male Female No Schooling 41.5 50.2 Nav. Nav. 25.8% 31.8% 57.3% 67.5% 39.0% 49.6% 28.7% 32.0% Median Years of 2.9 0 Nav. Nav 6.0 4.4 0 0 3.3 1.1 4.7 3.9 Schooling Adults unable to 36.9% 55.6% 10.3% 13.8% 29.5% 45.1% 54.3% 73.4% 29.2% 55.2% 19.1% 22.7% read newspaper

Trends Available data do not support trend analysis but as participation in basic schooling expands, adult literacy rates will increase. STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA GOAL #8. TO PROVIDE IMPROVED PROTECTION OF CHILDREN IN ESPECIALLY DIFFICULT CIRCUMSTANCES AND TO TACKLE THE ROOT CAUSES LEADING TO SUCH SITUATIONS. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Total disability rate 2.47% 1990 N/A -- N/A -- National 1990 Census (proportion of total population with reported mental or physical disability) Childhood disability rate N/A. -- N/A. -- N/A ------(children under the age of 15 with reported physical or mental 61 End Decade Report, Papua New Guinea

disabilit8ies)

Source of Data: The only data derives from the 1990 census as reported in PNG’s Initial Implementation Report on the CRC (page 66).

Discussion: According to PNG’s Initial Report on Implementation of the CRC, the 1990 census found 11,838 persons to be disabled of which 30% were under the age of 20 years (approximately 3,550 persons) and most living in rural areas. Based on WHO guidelines as well as local reports, these figures are clearly gross under-estimates. The CRC Report indicates that in the East Sepik Province 44% of school entrants suffer from hearing loss alone. Clearly there is a need for a properly organized study of disabilities.

Disparities and Trends: Given the paucity of data, analysis is not possible. STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA GOAL #9: TO GIVE SPECIAL ATTENTION TO THE HEALTH AND NUTRITION NEEDS OF THE FEMALE CHILD AND TO PREGNANT AND LACTATING WOMEN. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Life expectancy at birth (male-female) 52.2 51.4 1990/1 53.5 54.6 1996 N/A -- National DHS 1996, p.4. U5MR (male-female) N/A N/A. -- 108 91.3 1996 N/A -- National DHS 1996, p.83 U5 underweight (male-female) N/A N/A -- N/A N/A -- N/A -- Antenatal care 64% 1990 76.7% 1996 67% 1999 National 1990/99, DOH (pregnant women attended at least 1996, DHS, p.96 once by skilled health workers) Anaemia - nonpregnant N/A -- N/A -- N/A. ------(women aged 15-49 years with Hb levels below 12 grams/100) Anaemia – pregnant 69% 1987- 33% 11/95- 29% 1999 Port Moresby 1990=FAO, 1999 (pregnant women with Hb levels below 92 4/96 General 1995=ADB, 2000 1 grams/100 ml.) 1999=ADB, 2000 HIV-AIDS (Cumulative Number of N/A -- N/A -- 1404 1633 9/2000 National Nat’l AIDS Council Reported Cases to 9/2000)

HIV Prevalence N/A. -- N/A 30- 160- 2000 National UNAIDS estimate (Rate per 100,000 (male-female)) 130 330

Source of Data: Sources include the Ministry of Health (DOH, National Health Plan 2001-2010, Volume III.1), the Health and Demographic Survey of 1990 (DHS), Nutrition Country Profile (FAO, 1999), an ADB report on Safe Motherhood (2000), the National AIDS Council, and UNAIDS estimates based on epidemiological modeling techniques as reported by Preble, B., October 2000 (“Prevention of Mother-to-Child Transmission of HIV in PNG: An Assessment and Recommendations).

Discussion: Routine gender disaggregation of data remains a relatively new practice in PNG and one not yet universally undertaken, hence the paucity of data in the above table. Note that antenatal care (above) includes care rendered only by physicians or nurses and excludes care by village or traditional midwives. Note also that the coverage figure for 1976 is derived from the Demographic and Health Survey; the Department of Health estimate for the same year is 62%; the discrepancy cannot be explained at this time. Anaemia is known to be widespread in PNG, especially among women, but only small scale studies have been carried out. The figures above are based on mothers delivering in Port Moresby General Hospital. The prevalence of anemia nation-wide among pregnant women may be as high as 80% (UNICEF-GPNG, Children, Women and Families in PNG, 1996).

Disparities and Trends: Note that Gibson (1998, page 85) reports that nutritional risk appears to be equal for boys and girls, hence he does not report data disaggregated by gender. The situation with respect to HIV/AIDS is steadily worsening throughout the country. The higher risk apparently borne by women is a cause of great concern. STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA GOAL #10. ACCESS BY ALL COUPLES TO INFORMATION AND SERVICES TO PREVENT PRGNANCIES THAT ARE TOO EARLY, TOO CLOSE, OR TOO MANY. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Contraceptive Prevalence N/A -- 25.9 19.8 1996 26% 1998 National 1996=DHS, p.51 (women aged 15-49 protected by 1998=DOH, p.5. contraception either traditional or modern (married-all women)) Fertility rate for women 15-19 0.15 1991 0.13 1996 N/A 2001 National DHS 1991, SA,p.29 63 End Decade Report, Papua New Guinea

(livebirths per 1000 women age 15-19) pending DHS 1996, p.44 Total fertility rate 5.21 1991 4.8 1996 N/A 2001 National DHS, 1991, SA,p29 (average number of births to a woman data DHS, 1996, p.34. age 45-49) pending Women who know at least one N/A -- 71.8% 1996 N/A 2001 National DHS, 1996, p.47 method of contraception pending Women who know at least one source N/A -- 64.5% 1996 N/A 2001 National DHS, 1996, p. 47 of contraception services pending

Source of Data: All data are drawn from the Demographic and Health Surveys of 1991 and 1996 with the exception of 1998 contraceptive prevalence which is derived from the Department of Health information system as reported in Volume III.I of the 2001-2010 National Health Plan. Data for 2000-2001 will become available after the 2001 Demographic and Health Survey.

Disparities: There are differences between regions. Total fertility rates are lowest in the Highlands (4.36) and Southern (4.85) regions in contrast to Momase (5.33) and the Islands (5.26). While the lower rate for the Southern Region is influenced by the modern NCD sector, the lower rate for the Highlands is believed to be associated with higher rates of infertility resulting from STD infection. Information on knowledge of contraception and sources of contraception included above is not a part of the international indicators but will be useful for local monitoring when 2001 data becomes available.

Trends: Fertility rates are declining slowly. The Demographic and Health Survey (1996, page 71) documents a large unmet need for family planning services since the ideal family size is 3.58 or one child less than current completed fertility. STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA GOAL #11. ACCESS BY ALL PREGNANT WOMEN TO PRE-NATAL CARE, TRAINED ATTENDANTS DURING CHILDBIRTH AND REFERRAL FACILITIES FOR HIGH-RISK PREGNANCIES AND OBSTETRIC EMERGENCIES. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Antenatal care 69% 1990 76.7% 1996 67% 1999 National DOH 1996, SA,p.70 (pregnant women attended at least DHS 1996, p.96 once by skilled personnel) DOH 1999, p.124 Childbirth care 24% 1990 51.3% 1996 43% 1999 National DOH 1996, SA,p.70 (births attended by skilled personnel) DHS 1996, p.103 64 End Decade Report, Papua New Guinea

MOH 1999, p.126 Obstetric facilities –basic N/A -- N/A -- 1/360,000 2000 National ADB-IRETA (facilities providing basic essential est. obstetric care per 500,000 population) Health centers providing basic EOC ------10% 1998 Sample ADB-IRETA services survey Obstetric facilities – comprehensive ------1/276,000 2000 See ADB-IRETA (facilities providing comprehensive discussion obstetric care per 500,000 population) Provincial hospitals providing ------All 2000 See ADB-IRETA comprehensive EOC services discussion

Source of Data: Antenatal and birth attendance: 1990 data is derived from Department of Health publications as reported in the 1996 Situation Analysis of Children by UNICEF and GPNG. 1996 data derives from the Demographic and Health Survey. 1999 data derives from the National Health Plan 2001-2010, Volume III.1. Definitions used in 1990 and 1999 for “skilled personnel” and “trained attendants” are as determined by the Department of Health and cannot be verified from secondary data sources now available. In the 1996 Demographic and Health Survey “skilled personnel” and “trained attendants” included only nurses and physicians. This conservative definition will slightly understate the proportion of births attended by “trained personnel” since some TBAs are trained. However, the number of trained TBAs is relatively small as formal TBA training is limited to Milne Bay Province and a few church run facilities.

Obstetric facilities: Data are derived based on personal discussions by the compiler with an ADB-Safe Motherhood Consultant currently working in the country. He indicates that all provincial hospitals plus Port Moresby General meet WHO guidelines for “comprehensive obstetric facilities.” There are 17 provincial hospitals and an estimated population of 4.7 million. Thus the estimate of coverage by comprehensive facilities of 1:276,000 shown above. The consultant estimates that only about 10% of Health Centres meet WHO guidelines for basic obstetric facilities. There are 136 health centres in the country with a population of 4.7 million thus yielding the coverage ratio shown above of 1:360,000. (Note that all health centres meet some of the WHO criteria but few have all the components for a basic obstetric facility in place. The consultant is now preparing a formal report which will provide more definitive documentation of the estimates contained herein. (See also: “A Review of Safe Motherhood Policies and Strategies and their Impact on Women in PNG,” Report by an ADB consultant to the Department of Health, June, 2000, report disseminated by the DOH in draft form).

Discussion: Although PNG meets the minimum standards set by WHO for at least one comprehensive EOC facility and four basic EOC facilities to serve the population, these standards are not adequate in view of geography and logistics. In general, health centers should provide basic EOC services and provincial hospitals should provide comprehensive EOC services. A 1998 survey in selected provinces found only 10% of health centers to provide basic EOC services. STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA GOAL #12. REDUCTION OF LOW BIRTH WEIGHT (UNDER 2.5 KG) TO LESS THAN 10% OF LIVEBIRTHS. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Low birth weight rate N/A -- 9% 1997 10% 1999 National DOH 1999, p.126. (proportion of livebirths weighing less than 2500 grams)

Source of Data: Data are derived from the Department of Health, National Health Plan 2001-2010, Volume III.1, page 126. Data are derived from births in health facilities in which birthweight was taken and recorded. This is not a representative sample.

Discussion: Low birthweight among births occurring in PNG health facilities appears to be stable at around 10%. However, in view of maternal health indicators, it is possible that the actual incidence of LBW nationwide is higher, especially in Highland provinces where maternal underweight is particularly widespread.

STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA GOAL #13. REDUCTION OF IRON DEFICIENT ANAEMIA IN WOMEN BY ONE-THIRD OF 1990 LEVELS. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Anemia – non-pregnant N/A -- N/A. -- N/A ------(Women 15-49 with Hb levels < 12 g/100 ml) Anemia – pregnant 69% 1987- 33% 11/95- 29% 1999 Port Moresby 1990=FAO, 1999 (Pregnant women with Hb levels < 11 92 4/96 General 1995=ADB, 2000 g/100 ml) 1999=ADB, 2000

Source of Data: 1987-1992 data are derived from a survey of women delivering in Port Moresby General Hospital 1987-1992 as reported by FAO, 1999. Later years are as reported in “A Review of Safe Motherhood Policies and Strategies and their Impact on Women in PNG,” a report by an ADB consultant, June 2000. (Note that the 1999 data includes only women having Hb levels below 10 g/100 ml rather than the 11 g/100 ml which is the international standard).

Discussion: Anaemia is known to be widespread in PNG, especially among women, but only small scale studies have been carried out. The figures cited above are derived from women delivering in Port Moresby General Hospital. Surveys in other hospitals have only documented severe anaemia (Hb levels below 8g/100 ml. Rates of severe anameia have ranged from 5% (New Ireland, 1996) to 15% (West New Britian, 1998. Nation-wide the prevalence of anemia nation-wide among pregnant women may be as high as 80% (UNICEF-GPNG, Children, Women and Families in PNG, 1996).

Small scale surveys of children (under 5 years) have documented high rates of anaemia for this group. 1998 surveys in Madang, Sepick, and Western Highlands documented Hb levels < 11 g of 82%, 91% and 34.6% respectively. (Reference “Country Nutrition Profile,” FAO, 1999, page 24). STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA GOAL #14. VIRTUAL ELIMINATION OF IODINE DEFICIENCY DISORDERS. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Households consuming adequately N/A. -- N/A -- N/A ------iodized salt.

Population with urinary iodine levels N/A -- N/A -- N/A ------below 10 mcg/100 ml. Children aged 6-11 with any size of 12.6%-44% 1992- 28% Circa N/A --- Small area DOH, WSG, 2000 goitre (visible or palpable). 1993 1995 school surv. SA, 1996, p.

Source of Data: Widespread data on household consumption of iodized salt is not available. Small area surveys have suggested that many households do not consume sufficient salt to meet RDA for iodine. Goitre and cretinism have been documented as widespread in PNG among both children and women. Data shown above for school children are derived from rapid assessments in selected schools as reported in 1996 Situation Analysis of Children (pages 80-81.).

Discussion: Iodine deficiency is a widespread problem although no comprehensive surveys have been carried out. PNG recently passed a salt iodinization act and the Department of Health is now working to strengthen monitoring and enforcement of this act. Low levels of salt consumption, especially by poor households may undermine the effectiveness of this legislation in combating iodine deficiency disorder.

Trends: IDD was recognized as a serious problem in the 1950’s. Mass treatments using iodized oil injections were carried out in the 1970’s and rates seemed to decline. However, in the absence of prophylaxis over the past two decades, it appears that IDD is once more widespread. The current intervention of choice is salt iodinisation and PNG-DOH is working to implement this strategy nationwide. STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA GOAL #15. VIRTUAL ELIMINATION OF VITAMIN A DEFICIENCY AND ITS CONSEQUENCES, INCLUDING BLINDNESS. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Child Supplementation Vitamin A supplementation is not given routinely; by policy of the DOH, it is used ------(children 6-59 months who received a only for children suffering from a small number of clearly defined clinical high-dose Vitamin A supplement in the conditions. past 6 months). Maternal Supplementation See not above ------(mothers who received a supplement before infant was 8 weeks old) Low Vitamin A N/A. -- N/A. -- N/A ------(children 6-59 months with serum retinol below 20 mc/100 ml) 68 End Decade Report, Papua New Guinea

Night blindness-children N/A 1990 N/A. -- 1.1%-0.0% 1998 Madang; FAO, 1999, p.24. Sepik, WHP; sample of 1020 < 6

Night blindness – mothers N/A. -- N/A -- N/A ------(women who reported night blindness during last pregnancy)

Source of Data: Data are derived from FAO, “Country Nutrition Profile, 1999” (page 24).. See list of original citations in reference section which concludes this statistical annex.

Discussion: The child mortality rate in PNG is sufficiently high to warrant a presumption of VAD prevalence above threshold levels for a public health problem based on WHO criteria. However, a 1992 survey by US-AID of 1,027 hospitalised children found only 0.6% to be suffering from severe clinical Vitamin A deficiency. It is on this basis that the DOH formulated the current national policy in which supplementation is provided only to malnourished children suffering from measles or diarrhoea, (DOH, Draft End Decade Report, December 2000). STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA GOAL #16. EMPOWERMENT OF ALL WOMEN TO BREAST-FEED THEIR CHILDREN EXCLUSIVELY FOR FOUR TO SIX MONTHS AND TO CONTINUE BREASTFEEDING, WITH COMPLEMENTARY FOOD, WELL INTO THE SECOND YEAR OF LIFE. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Exclusive Breastfeeding Rate N/A -- 71.3 100 1996 N/A. 2001 National DHS 1996, p.114 (infants <4 months breastfed data (exclusive/with complementary)) pending Timely Complementary Feeding N/A -- 73.8% 1996 N/A 2001 National DHS 1996, p.114 (infants 6-9 months receiving data breastmilk & complementary food) pending Continued Breastfeeding Rate N/A -- 92.3% 1996 N/A. 2001 National DHS 1996, p.114 (Infants 12-15 months breastfeeding) pending Continued Breastfeeding Rate N/A -- 34.2% 1996 N/A 2001 National DHS 1996, p.114 (Infants 20-23 months breastfeeding) pending

Baby Friendly Hospitals -0- 1990 4 1996 4 2000 National NPO, 2000 (Number of BFHI certified facilities)

Source of Data: Data on breastfeeding practices are derived from the 1996 Demographic and Health Survey. A follow-up survey undertaken in 2001 will provide updated statistics. BFHI data are is derived from the National Planning Office draft End Decade Report for UNICEF, December 2000.

Discussion: Breastfeeding is virtually universal in PNG. However, early introduction of complementary feeding is common, hence the lower figure shown for exclusive breastfeeding. Breastfeeding traditionally continues well into the second year of life or even beyond. By law, bottles and teats are available in PNG only by prescription; in practice, even with prescription, bottles and teats are only available in urban areas. The BFHI initiative was launched in PNG in 1992 at which time 18 facilities were targeted for certification. Since 1992, 12 have completed staff training. Eight have been reviewed and four have been designated as baby friendly (Lorengau, Alotau, Kavieng, and Popondetta).

Disparities and Trends: There are no trends away from breastfeeding at this time. UNICEF is assisting the Department of Health and the National AIDS Council to review protocols in view of the HIV epidemic. However, breastfeeding is expected to remain the recommendation except in exceptional cases. STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA GOAL #17. GROWTH PROMOTION AND ITS REGULAR MONITORING TO BE INSTIUTIONALIZED. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Clinic attendance by infants < 1 year 96% 1990 95% 1995 N/A. -- National DOH, 1996, SA,p.70

Source of Data: The above data are derived from Department of Health statistics as reported in the 1996 Situation Analysis of Children. Figures refer to infants seen at least once by health personnel during the first year of life. While most of these infants will be weighed as a part of their encounter, this should not be construed as indicating of a meaningful growth monitoring experience resulted. Nutrition data indicate that children are at greatest risk of malnutrition during the second year of life. There is no data on clinic attendance for two-year olds.

Discussion: Growth monitoring has been a routine part of MCH services in PNG for over a decade. A “road to health” chart is included into the family-held child health record although the 1996 DHS found that mothers could produce a record for only 68% of children aged 12-23 months. Weighing is a standard part of 70 End Decade Report, Papua New Guinea

the child health clinic in both fixed clinics and mobile clinics. In some areas though, only younger children are weighed due to unavailability of standing scales. Weighing may also not be done in mobile clinics if the immunization workload is heavy. A major concern is that weighing is often a “mechanical” exercise with little effort to provide clinical or home-based interventions in the case of children who are underweight or losing weight. Because of these problems, the proportion of PNG children who participate in a meaningful and regular growth monitoring program is believed to be quite small. To remedy these problems, UNICEF and the Department of Health have recently embarked on a pilot project in Milne Bay and Madang Provinces which aims to introduce and sustain community-based growth monitoring. If these pilot projects are successful, the Department is committed to integrating the approach within national protocols.

. STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA GOAL #18. DISSEMINATION OF KNOWLEDGE AND SUPPORTING SERVICES TO INCREASE FOOD PRODUCTION TO ENSURE HOUSEHOLD FOOD SECURITY. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Dietary energy supplies per person 1756 1965 2269 1995 N/A -- National FAO, 2000, Part II (kcal/day/person available) Dietary energy requirements per 2136 1995 2147 1995 N/A -- National FAO, 2000, Part II person (kcal/day/person needed) Food deficit/surplus (kcal/day/person) - 380 1965 + 122 1995 N/A -- National FAO, 2000, Part II Population without access to adequate 27% 1969- 10% 1990- N/A -- National FAO, 2000, Part II food supplies 1971 1992 Value of food imports (millions) K 200 1991- K 325 1995 K 600 2000 National DAL 2000, p.7. 1992

Source of Data: Food surplus/deficit data is derived from FAO calculations as reported in the FAO Nutrition Country Profile, 1999, Part II (Table 2). Data on food imports is derived from the National Food Security Policy, May 2000, Department of Agriculture and Livestock.

Discussion: The food security situation in households has improved in past decades but primarily as a result of increased access to imported foods (especially rice and other cereals) rather than as a result of increased domestic production of traditional staple crops. This dietary change away from traditional crops toward cereal crops has both positive and negative nutrition implications. The change may help reduce malnutrition among young children who are not physiologically capable of digesting large quantities of bulky root crops. The change will however, contribute to vitamin and mineral deficiencies and to adult obesity with its attendant problems of increasing non-communicable diseases. The Government has recently prepared a National Food Security Policy, 2000- 71 End Decade Report, Papua New Guinea

2010, which aims to improve national and household food security primarily through increased domestic production and enhanced efficiency within domestic food distribution networks. . STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA Goal #19. Eradication of polio by the year 2000. Goal #20. Elimination of neonatal tetanus by 1995. Goal #21. Reduction in measles deaths by 95% and measles cases by 90% of pre-1995 levels. Goal #22. Maintenance of high levels of immunisation coverage (BCG/DPT,OPV, Measles) among infants and women of child bearing ages (tetanus toxoid). Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Annual number of polio cases reported N/A -- -0- 1995 -0- 1995 National NPO EDR 2000 Annual number of neonatal tetanus 163 1992 134 1995 N/A -- National 1992/5=SA, p.82 cases reported Annual number of measles deaths 44 1990 12 1995 15 1997 National NPO EDR, Figure 4 (all persons) Annual number of measles cases (all 4,575 1990 438 1995 314 1997 National NPO EDR, Figure 5 persons) 1-year old children immunised with 81.8% 1989 88% 1995 76% 1999 National 1989=DOH 91, p.229 BCG 1995=DOH 00, p.130 1999=DOH 00, p.130 1-year old children immunised with 53.3% 1989 60% 1995 60% 1999 National 1989-DOH 91, p.232 DPT-3 1995=DOH 00, p.134 1999=DOH 00, p.134 1-year old children immunised with 51.6% 1989 67% 1995 48% 1999 National 1989=DOH 91, p..231 three doses of OPV (excluding OPV 1995=DOH 00, p.132 given at birth) 1999=DOH 00, p.132 1-year old children immunised against 52.4% 1989 42% 1995 53% 1999 National 1989=DOH 91, p.228 measles 1995=DOH 00, p.134 1999=DOH 00, p.134 Pregnant women protected against N/A -- 44.6% 1995 44% 1999 National DOH, 00, p.124. neonatal tetanus through tetanus

toxoid immunisation.

Source of Immunisation-Related Data: All data are derived from the Department of Health as reported in: (1) PNG National Health Plan, 1991-95; (2) National Health Plan 2001-2010; or (3) National Planning Office, Draft End Decade Report for UNICEF, December 2000.

Discussion: Despite concerted effort and substantive investment in immunisation over the past decade, progress has been sporadic and unsustained at the national level. Although coverage levels are below target, disease incidence is declining. In 2000 PNG was declared to be “polio free” by WHO. STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA Goal #23. Reduction by 50% in deaths due to diarrhoea in children under the age of five years and 25% reduction in diarrhea incidence among children under the age of five years. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Deaths due to Diarrhea (all ages) 204 1990 162 1995 182 1997 National DOH 2000, p.68 Admission due to Diarrhea (all ages) 8,361 1993 7,618 1995 7,536 1997 National DOH 2000, p.68 U5 Diarrhea Cases N/A -- 4.3 1996 N/A 2001 National DHS 1996, p.110 (average annual diarrhea episodes per data child 0-36 months of age) pending ORT Use Rate N/A --- 38.6% 1996 N/A 2001 National DHS 1996, p.112 (proportion of children with diarrhea data treated with ORS or ORT) pending Home Management of Diarrhea N/A -- 35.2% 1996 N/A --- National DHS 1996, p.112 (proportion of children 0-36 months who received increased fluids)

Source of Data: Death and admission data are derived from the Department of Health information system as reported in the National Health Plan 2001-2010, Volume III.1. These data refer to all ages, not just children under the age of 5, as specified in international monitoring standards. Data on management of diarrhea are derived from the Demographic and Health Survey of 1996 and refer to children 0-36 months of age rather than 0-59 months of age as specified in international monitoring standards. Note that “home management of diarrhea” requests information on children receiving increased fluids and feeding; the DHS data refers only to increased fluids without mention of continued feeding (page 112, Table 9.11).

STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA Goal #24. Reduction by one-third in deaths due to ARI among children under the age of five years. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population U5 Deaths Due to ARI No data available (Annual number of reported deaths) Annual Number of Reported Deaths 1,162 1993 884 1995 822 1997 National DOH 2000 p.100. Due to Pneumonia (all ages) Care Seeking for ARI No data available (U5 children with ARI taken to a health provider) Care Seeking for ARI N/A -- 74.9% 1996 N/A 2001 National DHS 1996, p.109. (children 0-36 months who had cough data and fast breathing that received care pending in a health facility)

Source of Data: Death data are derived from the Department of Health information system as reported in the National Health Plan 2001-2010, Volume III.1. These data refer to all ages, not just children under the age of 5, as specified in international monitoring standards. Data on management of diarrhea are derived from the Demographic and Health Survey of 1996 and refer to children 0-36 months of age rather than 0-59 months of age as specified in international monitoring standards. 2001 data will be available following completion of the 2001 Demographic and Health Survey.

STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA Goal #25. Elimination of guinea-worm (not applicable to PNG). Goal #26. Expansion of early childhood development activities. Goal #27. Increased acquisition of knowledge, skills, and values for better living through non-formal education and mass media. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source

Data Year Data Year Data Year Population Annual cases of guinea-worm Not applicable to PNG -- -- Preschool Development See notes below -- -- (children 36-59 months attending organized ECEP) Knowledge for Life No indicators developed for this. -- --

Source of Data: Assessment of the education for all initiative includes some data on early childhood education. However, it is not comparable across years because of a distortion introduced under education reform whereby elementary education (k-3) is displacing community based preschools in many areas.

STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA Goal #28. Universal ratification of the Convention on the Rights of the Child and implementation of the same. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Ratification of the CRC --- Yes 1993 ------Submission of initial implementation ------Yes 2000 -- -- report Proportion of children whose births are N/A -- N/A -- 2% 2000 National UNICEF PNG 2000 registered Living Arrangements No data -- -- (children 0-14 in households but not living with a biological parent) Orphans No data -- -- (children 0-14 in households who are orphans) Child Labour No data; survey planned for 2001 -- -- (children 5-14 who are working)

Source of Data:

There is virtually no data to assess the indicators above other than an estimate by UNICEF-PNG that legal birth registration currently extends to only 2% of PNG children, (see “Addressing the Challenge of Unregistered Children in PNG,” UNICEF, 2000). A survey on child labour will be conducted by UNICEF and the Department of Labour in 2001. Other information on living arrangements may be available when the 2000 census report is released.

STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA Additional Indicators for Monitoring the Integrated Management of Childhood Illnesses (IMCI). Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Home Management No data -- -- (children 0-59 months reported ill who received increased fluids and continued feeding) Care Seeking No data -- -- (caregivers of children 0-59 months who know at least 2 symptoms requiring immediate health care) Malaria Treatment No data -- -- (children 0-59 months ill with fever who received anti-malaria drugs) Malaria Treatment Nav -- 47.7% 1996 Nav. 2001 National DHS 1996, p.109 (children 0-36 months ill with fever data who were taken to a health facility. pending Impregnated Bednets No data -- -- (children aged 0-59 months who sleep under an impregnated bednet)

Source of Data: Data are not available to assess PNG’s status against the above-state international indicators. The only related data is care-seeking behavior for children 0-36 months in the case of fever. This is derived from the 1996 Demographic and Health Survey. IMCI is a new initiative in PNG; it may be expected that pilot surveys will be undertaken in the future to collect baseline data relevant to the above.

STATISTICAL INDICATORS FOR MONITORING PROGRESS TOWARD END-DECADE GOALS PAPUA NEW GUINEA Additional Indicators for Monitoring the HIV/AIDS Situation. Indicator Circa 1990 Circa 1995 Circa 2000 Reference Data Source Data Year Data Year Data Year Population Number of HIV-AIDS infections 70 1990 371 1995 3,879 June National 1990/5=SA, p.87 (cumulative case reports) 2000 National Aids Council Women who know about AIDS --- -- 64.6% 1996 N/A. 2001 National DHS 1996, p.119. pending Women who know a way to avoid -- -- 57.9% 1996 N/A Ditto National DHS 1996, p.122 AIDS Women who can state the three main No Data -- -- ways to avoid AIDS Women who know that a healthy -- -- 44.7% 1996 N/A Ditto National DHS 1996, p.124. looking person can have AIDS Women who correctly identify three No Data -- -- misconceptions about AIDS Women who correctly identify means No Data -- -- of transmission from mother to child Women expressing a discriminatory No Data -- -- attitude toward people with AIDS Women who know where to get an No Data -- -- AIDS test Women who have been tested for HIV Women who state it is acceptable for a No Data -- -- woman to ask a man to use a condom Median age of girls at first birth -- -- 21 1996 N/A 2001 National DHS 1996, p.42 pending

Source of Data: Data on HIV infection are derived from the National AIDS Council for 1999 and the Department of Health for earlier years as reported in the 1996 Situation Analysis of Children (page 87). Data on knowledge, attitudes and practices with respect to HIV/AIDS are derived from the 1996 Demographic and Health Survey. In most cases available data (as shown above) are not in the internationally requested format, hence the large number of entries for which there is an entry “no data.”. 77 End Decade Report: PNG, Annex A

ANNEX A. FORUM ON RESPONSIBLE LEADERSHIP FOR CHILDREN UNIVERSITY OF PAPUA NEW GUINEA, OCTOBER 25-27, 2000

SUMMARY OF RECOMMENDATIONS BY PARTICIPANTS

1. CHILD SURVIVAL MOTHER AND CHILD HEALTH

1. Promote responsible parenting, especially among young and intending parents through counselling and education. 2. Educate males in family planning as well as females. 3. Enhance knowledge of home care among parents through multi-sector partnerships in producing public education programmes and campaigns. 4. Strengthen partnership between government and non-government organisations; build capacities of NGOs through training for required technical knowledge and funding support. 5. Strengthen capacities at the community and family level by increasing knowledge and promoting appropriate nutrition practices- interventions; review positive aspects of traditional practices in nutrition care and build upon them. 6. Ensure community health visits especially in rural areas. 7. Increase and maintain immunisation coverage. 8. Establish separate hospitals for children.

Child Development Early Childhood Care and Development (ECCD) 1. Identify and fulfil specialised training needs in ECCD. 2. Review current work of NGOs in ECCD; consolidate these efforts in order to further develop the ECCD concept and services. 3. Clarify target ages for ECCD services. 4. Train parents and caregivers on what they can and should do in the home to stimulate early childhood development. 5. Recognise/revive/encourage and build upon the rich PNG tradition of early child care and the nurturing environment traditionally provided within the family. A-78 End Decade Report: PNG, Annex A

6. Make available special courses at the diploma level on ECCD at higher educational institutions in the country. 7. Network and co-ordinate among ECCD proponents and service providers in order to avoid wasteful duplication of effort.

EDUCATION 1. Vigorously promote education of the girl child. 2. Create and/or strengthen the Child Rights Desk; build the capacity of this desk to pursue children’s rights to an education. 3. Inform people in simple, clear language about “education reform.” Explain the various definitions used in education reform in order to remove confusion and enhance participation. 4. Build “human rights and child rights” into all teacher training courses. 5. Recognise and tap the potential of youth as leaders and active partners in all activities affecting children. 6. Establish a National Children’s Day for the proper recognition of children’s rights and as a recurring reminder of society’s obligations to children.

Rights of the Disabled Child (General) 1. Ensure registration of children at birth. 2. Ensure that the clinic book (health) includes a record of issues related to disabilities (kind of disability, etc). 3. Develop an efficient medical referral system to ensure early referral of children to sources of assistance. 4. Create general awareness and build effective participation among civil society, government, non-government organisations, churches, etc. in meeting the needs of disabled children. 5. Build closer collaboration among partners, including departments within government (e.g. health, education, social welfare, etc.). 6. Absorb/assimilate/rehabilitate disabled children within their families and not in institutions. 7. Stop using disabled children in undignified activities such as street begging. 8. Create greater public awareness and provide parent education to remove the stigma associated with disabilities and enhance the care and development of the disabled child.

Rights of the Disabled Child (Special Education) 1. The rights of the disabled child to an education must be seen in the context of the overall rights of all children and the principle of non- discrimination. 2. Promote integrated-inclusive education for the disabled. 3. Make provisions for specialised training of teaching staff as necessary. 4. Move away from an urban focus of services and expand into rural areas where most disabled children live. 5. Strengthen capacities of parents and caregivers to assist their disabled children. A-79 End Decade Report: PNG, Annex A

6. Network and co-ordinate among agencies and service providers to avoid wasteful duplication of efforts. 7. Increase the number of special education centres in the country to cater for those who will need such services and ensure even distribution of these centres (at least one per province).

Child Protection IDENTITY OF THE CHILD 1. Improve birth registration through more public information. 2. Work toward making birth registration compulsory. 3. Birth registration should include reference to biological parents. 4. Make the registration system, including the forms and tools, more “user friendly” by simplifying forms. 5. Health department and health facilities can help to process the birth registration of all children born under professional supervision by issuing necessary documentation.

Children and the Law 1. Make penalties for sexual offences more rational (e.g. review the wisdom of current practices whereby lesser penalties are imposed for offences against the boy child or against younger children). 2. Use simple language in court and in legislation. 3. Use simple language booklets for children on child rights and the law using local languages (e.g. pidgin and motu). 4. Provide special training for judges and prosecutors. 5. Establish suitable court procedures including appropriate furniture and dress in order that children will feel more comfortable in court. 6. Offer child witnesses opportunities such as social workers, parents to be present during proceedings, closed courtrooms, etc. 7. Use the media to create public awareness about the special needs of children before the law. 8. Undertake a victim impact assessment as early as possible and initiate the recovery process for child victims as soon as offences have been reported. 9. Provide separate arrangements for juvenile offenders from adult criminals at all stages of custody. 10. Institute separate courts and dedicated judges and prosecutors for child and family matters.

CHILD LABOUR 1. Define child labour in the PNG context by conducting necessary research; identify categories and extent of child labour in the country. A-80 End Decade Report: PNG, Annex A

2. Strengthen and apply effective measures to prevent all extreme forms of violation of child rights and exploitation of children such as child prostitution, hazardous labour, child trafficking, drugs, children in the armed forces, etc. 3. Review existing laws and make effective application of laws to combat child labour. 4. Invite and help youth and children to express their own views on all forms and aspects of child labour. 5. The Department of Labour should organise a forum to discuss child labour issues.

Child Participation 1. All children must be given a chance to participate in family and community life according to their abilities and in matters affecting their own lives, such as: 1.1. In the process of assessing their situation  Rights and special needs of children  Status of fulfilling or denying these rights and needs 1.2. In the process of analysis of the causes and who is responsible among the various stakeholders  Who does what well or poorly?  How do these behaviours affect children’s lives? 1.3. In suggesting means to address their needs  What should happen?  What should stop happening?  What facilities and services should be in place? 1.4. In expressing themselves effectively  So they are heard by the right people at various levels (families, institutions, schools, government, politicians)  So they are heard collectively and individually  So they are heard often  So they are listened to and their issues discussed with them  So their best interest is protected and taken into consideration in every adult decision in their sphere. 2. Form and sustain a dedicated media group for children with the inclusion of non-media persons including children and youth. Work closely with the Media Council whose code of ethics clearly fosters a focus on children. 3. Create greater awareness of the importance of children’s participation in society at large (particularly among parents who are the primary source of influence and empowerment of children and also among community decision-makers). 4. Promote, popularise, and institutionalise school and community based activities (child-to-child, child-to-parent, etc). 5. Strengthen the Boy Scout and Girl Scout movements.

A-81 End Decade Report: PNG, Annex A

6. Make provisions for regular special programmes for children in provincial and national radio and television (as an extension of the concept of International Children’s Day of Broadcasting). 7. Scale up the proposed National Children’s Day into a National Day for all through annual events for fun and participation by all children and renewing public pledges by national leaders (media to propagate such pledges internationally). 8. Form a Parliamentary Group for Children and dedicate specific time slots in the national parliament for discussing children’s issues.

ANNEX B.

PNG And The International Development AGENDA OF THE 1990’S

CONTENTS

 CHILDREN (GENERAL) B- 2  CHILD LABOUR B- 3  EDUCATION B- 4  FOOD SECURITY B- 6  HEALTH B- 7  HIV-AIDS B- 9  HUMAN RIGHTS B-10  LITERACY B-11  NUTRITION B-12  POVERTY AND SOCIAL DEVELOPMENT B-13  POPULATION B-14  SUSTAINABLE DEVELOPMENT AND THE ENVIRONMENT B-15  WOMEN B-16

ISSUE: CHILDREN (GENERAL)

GLOBAL AGENDA: World Summit Declaration and Plan of Action (1990) International Convention on the Rights of the Child (1989)

PNG RESPONSE: Signatory to World Declaration and Plan of Action (1990) Ratification of the CRC (1993)

GOVERNMENT RESPONSE SUMMARY:  Government did not develop an integrated National Plan of Action in response to the World Summit Declaration and Plan of Action. Government responded to the most pressing needs of children through an Education For All Initiative and a Child Survival Crash Programme.  A holistic situation analysis that responds to survival-development-protection-participation themes of the CRC was not prepared until 1999 in the form of the Initial Implementation Report on the CRC (endorsed by the National Executive in October 2000). This report emphasises the need for greater attention to protection issues as well as the need for a central co-ordinating and monitoring body.  Government, through the Department of National Planning, is committed to preparing a national plan of action for the period 2001-2010. To this end, an initial outline of recommendations has been prepared by a Leadership Forum convened by the University of Papua New Guinea in October 2000 (Annex A).  Government is now considering ratification of additional treaties: (1) the Optional Protocol to the CRC on Child Soldiers; (2) the Optional Protocol to the CRC on Sexual Exploitation; and the (3) the Land Mines Treaty.

IMPACT OF GOVERNMENT RESPONSE:  Reasonable progress has been made in implementing education reform to address the priority World Summit goals for education. As a result of reform, more PNG children are entering school although dropout rates remain high. Gender inequity has been reduced but not yet eliminated.  Significant effort and resources have been directed toward health improvement particularly through the 1994-97 Child Survival Crash Programme and the more recent Health Systems Improvement Project. Health indicators, however, continue to be poor (Annex C).  To provide a basis for effective response to protection issues as provided for in the CRC report, government has initiated assessments of: (1) birth registration; (2) child abuse and neglect; (3) child labour; and (4) harmful traditional practices.

ISSUE: CHILD LABOUR

GLOBAL AGENDA: ILO Convention on the Worst Forms of Child Labour (1999)

PNG RESPONSE: Ratified ILO Convention on the Worst Forms of Child Labour (2000)

GOVERNMENT RESPONSE SUMMARY:  Having now ratified the Convention, the Department of Labour, in co-operation with UNICEF, is undertaking a study of child labour in PNG. This study will focus initially on those workplaces where anecdotal evidence suggests child exploitation may be occurring.  There is also need is to look more closely at children’s work in the home and family. It is well known that many children, especially girls, are required to undertake domestic duties that interfere with their health and education. Problems may also arise when children are informally adopted or sent to live with relatives in town to complete their schooling. These children often do not have equitable access to the resources of their host family and may be required to undertake work that interferes with their schooling. These issues were highlighted in the CRC report and will need to be the subject of future investigation.

IMPACT OF GOVERNMENT RESPONSE:  It is too early to project the nature and impact of government’s responses to child labour issues.

ISSUE: EDUCATION

GLOBAL AGENDA: World Summit Declaration and Plan of Action (1990) Education for All Declaration and Plan of Action (1990)

PNG RESPONSE: Manae Report sets foundation for education reform in PNG (1985) Signatory to Jomtien Declaration on Education for All (1990) Education Sector Review (1991) National Special Education Plan and Policy Guidelines (1993) Education Amendment Act (1995) Teaching Service Amendment Act (1995) National Education Plan (1996) National Education Plan Update (1999) Education for All Review (1999) Participation in the End Decade Review of the EFA Initiative (2000)

SUMMARY OF GOVERNMENT RESPONSE:  Since 1991, PNG has embarked on a programme of Education Reform that responds to local issues and local recommendations but in the context of the International Education for All Initiative, the CRC, CEDAW, and the Copenhagen Declaration on Social Development.  The aim of the programme is to create “a national education system researched and supported by partnerships of all stakeholders at all levels and which produces literate, educated and skilled citizens prepared for development and challenge.” Explicit in the reform programme is the aim of achieving universal primary education relevant to PNG life at an affordable cost.  The reform programme is comprised of four sub-programmes: (1) the Education Access and Expansion Programme responsible for reforming the institutional structure of the education system; (2) Relevant Education for All Programme responsible for pedagogical reform; (3) the Literacy and Information Programme which addresses non-formal education; and (4) the Higher Education programme which aims to meet national human resource development requirements.  Strategies to redressing gender inequalities are integrated throughout the four sub-programmes.  The reform programme was piloted in 1993 with nation-wide expansion introduced progressively from 1996. The target is full national implementation by 2004 although authorities admit that 2010 may be more realistic. A-85 End Decade Report: PNG, Annex A

 Under reform, the education structure is comprised of (1) three years of village-based elementary schooling (Preparatory, Grades 1 and 2) in the vernacular; (2) six years of primary education in English; (3) two years of lower secondary schooling or alternately of vocational training; and (4) two yeas of upper secondary. Tertiary education consists of colleges, universities, and technical training institutions.  In 1993 The Department of Education promulgated a policy and plan to meet the needs of disabled children. This document: (1) reaffirms that disabled children have equal rights to education resources together with the non-disabled at all levels of schooling; (2) where possible, disabled children should be “mainstreamed” into regular schools and classrooms; (3) grants should be given to NGOs to enable them to establish education programmes for disabled children who cannot be “mainstreamed;” (4) teachers should received training in dealing with the needs of the disabled within their normal classrooms.

Education for All (continued…)

IMPACT OF GOVERNMENT RESPONSE:  The education reform programme represents a tremendous national investment by government and the donor community. The programme has successfully expanded access to basic elementary education as evidenced by a 50% increase in gross enrolment (1991-97). It has not, however, yet succeeded in overcoming gender inequities or achieving retention goals. Although more than 90% of children now begin schooling, only 57% complete the six years of education considered to be the minimum level for effective living in PNG society.  There are many factors in the success of the programme to-date. Three are of particular importance: (1) strong and consistent support by succeeding governments throughout the 1990’s; (2) strong and consistent support by overseas development partners; and (3) development of a system of co- ordination, monitoring and surveillance through the Facilitating and Monitoring Unit of the Department of Education which in turn is closely linked to the implementation units at national and provincial levels.

ISSUE: FOOD SECURITY

GLOBAL AGENDA: Declaration of the World Food Summit (1996)

PNG RESPONSE: Signatory to the Declaration of the World Food Summit (1996) National Nutrition Policy (1995) National Food Security Policy (May 2000)

GOVERNMENT RESPONSE SUMMARY:  PNG has been classified by FAO as a Low Income Food Deficit Country as a result of its increasing dependence on food imports. Between 1980 and 1990, the agriculture sector grew by an average of 1.7% against a population growth rate of 2.3%. The deficit was bridged by imports, particularly of cereals (rice and flour).  The National Food Security Policy aims to increase and diversify food production in order to achieve greater self-sufficiency in food and attain food security at the national and household levels by 2015.  This objective is to be realised through increased agriculture production and income earnings from domestic and export marketing of food products. At the same time, nutrition status, household income and standards of living will be enhanced, especially in rural areas.  The policy supersedes the National Nutrition Policy of 1978 and complements the National Nutrition Policy of 1995.

IMPACT OF GOVERNMENT RESPONSES:  It is premature to assess the impact of the National Food Security Policy.

ISSUE: HEALTH

GLOBAL AGENDA: Declaration of Alma Alta (Health for All, 1978) Universal Child Immunisation (1980’s) World Summit Declaration and Plan of Action (1990) Health Islands Initiative (Yanuca and Rarotonga Accords)

PNG RESPONSE: Child Survival Crash Programme (1984-1987) National Health Plan 1991-1995 National Health Plan 1996-2000 Mid-Term Review of the National Health Plan 1996-2000 (1998) National Health Plan 2001-2010 PNG certified as “polio free” (2000)

GOVERNMENT RESPONSE SUMMARY:  In response to the global push for Universal Child Immunisation in the 1980’s, PNG exerted extraordinary effort. Although nation-wide coverage never quite reached the 80% target set by the UCI programme, it did reach levels approaching 70%. However, coverage levels fell shortly after the end of the UCI initiative as a result of deteriorating outreach services.  In response to the World Summit goals for child health, deteriorating immunisation levels, and stagnating mortality levels, PNG launched a Child Survival Crash Programme (1994-97) with assistance from UNICEF and AusAID. The primary aim of the programme was to increase access to essential MCH services through an invigorated programme of mobile clinics and patrols. While the priority focus was immunisation, this was to be the “cutting edge” for a range of MCH services.  In 1995 an amended Organic Act was enacted which provided for strengthening of district and local level governments and devolution of administrative responsibilities to this level while strengthening requirements that lower level governments adhere to a policy framework set by the National Government. Implementation of this act was slow at the outset but has rapidly accelerated in the past eighteen months under the current government.  In line with the Organic Act, a Health Administration Act was passed in 1997. This Act clarified roles and responsibilities of each level of government in health affairs. It requires district and local planning and initiative while simultaneously requiring each level of health administration to adhere to a broad policy framework established at national level albeit in consultation with lower levels of administration. This is a major structural reform deemed essential for forward progress toward health targets. A-88 End Decade Report: PNG, Annex A

 The new health plan (2001-2010) identifies five priority problems: (1) health of the people, especially women and children, is not improving; (2) resources are limited; (3) management is inefficient; (4) access to basic health services is inadequate; and (5) community support is poor and individuals and communities are not encouraged to improve and maintain their own health.  The plan aims to improve the health of all through a health system that is responsive, effective, affordable, acceptable and accessible. The plan also aims to empower individuals, families and communities to take responsibility for their own health and to involve all levels of government and other partners to work together toward achieving national health goals.  The plan identifies eight national priorities: (1) health promotion; (2) family health with a focus on women and children; (3) elimination, eradication or control of priority diseases; (4) health protection; (5) human resource management; (6) strengthening district and hospital services; (7)

Health (continued…)

improving access to medicines and medical supplies; and (8) strengthening partnerships for health.  Priority 8 – strengthening partnerships – is a direct response to the Health Islands Initiative proposed by WHO and adopted as a forward reaching strategy by Pacific Island Health Ministers in the Yanuca Accord of 1995.  In accordance with health plan priority number three, priority diseases include: STDs, tuberculosis, pneumonia, diarrhoea diseases, measles, leprosy, polio, cholera, dengue fever, malaria, diabetes, coronary heart disease, obesity, and cancer.

IMPACT OF GOVERNMENT RESPONSES:  The Child Survival Crash Programme resulted in short-term localised improvements in clinic coverage and immunisation rates. Ultimately these improvements were not sustainable at national levels by government’s own efforts once donor involvement ceased. Funding, however, was not the critical issue. One critical issue was the overall structure and management of the health system characterised by poor planning, inadequate co-ordination between levels of service, and inadequate controls. A second critical issue was the wider socio-economic—political environment of the country during the latter half of the 1990s, which was characterised by increasing political instability, economic crisis, and an unprecedented series of natural disasters. These events effectively negated many of the positive impacts of the CSCP.  The Health Administration Act aimed to address structural issues impeding health services by (1) clarifying roles and responsibility; (2) establishing minimum standards for service delivery; (3) strengthening the planning and management authority at the district level; (4) increasing participation in health management by local level governments and ultimately by communities themselves.  As part of the 1996-2000 Health Plan implementation, a revitalised health information system was instituted. This is providing far better and far more complete data on locally defined “core indicators” than available in past years. However, data still reflects only the health status of those persons who access the health system; it is therefore not representative of the population as a whole. While the most recent data continue to show little substantial

improvements in health indicators, this may be an artefact of reporting time lag. A better assessment of progress can be prepared once census (2000) and demographic and health survey (2001) data become available.  A particular challenge is effective engagement of local governments and communities to take more responsibility for their own health. Pilot projects are underway in several locations to learn how to achieve, sustain, and replicate community participation in health. One such project is the DOH/UNICEF Community Based Growth Monitoring Initiative in Milne Bay and Madang Provinces. Another approach is a Healthy Islands pilot project underway in Madang with assistance from WHO.

ISSUE: HIV-AIDS

PNG RESPONSE: Establishment of a National AIDS Surveillance Committee (1987) First Medium-Term AIDS Plan (1989-1995) National AIDS Control Act (1997) Establishment of a National AIDS Council (1997) Second Medium Term HIV-AIDS Plan (1998-2002) Launch of a national HIV-AIDS support project with AusAID (2000-2005)

GOVERNMENT RESPONSE SUMMARY:  The first HIV case in PNG was reported in 1987. Since that date, the number of reported cases has steadily escalated so that as of September 2000 PNG has a cumulative total of 3,145 cases of which 792 were diagnosed since January 2000. Because reported cases constitute only the “tip of the iceberg,” the actual number of persons living with HIV-AIDS is variously estimated with a range between 5,000 to 15,000. The number of known AIDS orphans is now 1,100 children; this number far exceeds the capacity for effective response on the part of social welfare.  HIV-AIDS is spread in PNG primarily through unprotected heterosexual contact. The worst hit regions are the National Capital District, the Highlands, and Morobe Province although every province has reported at least one case indicating that the infection is widely spread throughout the country.  In 1987 Government established the National AIDS Surveillance Committee that prepared the first medium term plan for Prevention and Control of AIDS (1989-95).  The National Health Plan 1996-2000 provided an additional policy framework for addressing HIV-AIDS.  In 1997, the National AIDS Control Act was passed. This act strengthens government’s response to the epidemic by ensuring a multi-sectoral response that protects and promotes human rights and dignity.  The medium-term plan for 1998-2002 sets a five—point HIV-AIDS strategy: (1) to improve sexual health with emphasis on preventing and controlling transmission of STDs and HIV; (2) to reduce the impact of HIV-AIDS on individuals and families through treatment, care, and support services; (3) to create a supportive legal and ethical environment for HIV-AIDS prevention and care and to uphold the human rights of persons infected and affected by HIV-AIDS; (4) to minimise the negative social and economic consequences of the HIV-AIDS epidemic; and (5) to strengthen the national capacity to respond to the epidemic.  A network of multi-sectoral Provincial AIDS Councils augments responses at national level.

IMPACT OF GOVERNMENT RESPONSE:

 From the late 1980’s the nation’s blood supply has been protected. Work in the 1990’s focused on awareness and health education for behaviour change. As the epidemic has spread, protection of basic human rights and palliative support to reduce the social and economic cost of HIV-AIDS to families and communities has also become a focus of effort.  It is premature to assess the impact of the Medium term HIV-AIDS plan at this time.  The best case scenario is that it will require 5-10 years of concerted implementation to halt the epidemic.

ISSUE: HUMAN RIGHTS

PNG RESPONSES: Ratification of the CRC (1993) Ratification of CEDAW (1994) Participant in the World Conference on Human Rights (1993) Ratification of the Elimination of all Forms of Racial Discrimination Ratification of the Convention on the Status of Refugees

GOVERNMENT RESPONSE SUMMARY:  In 1993 at the World Conference on Human Rights, the PNG Government made a commitment to establish a Human Rights Commission. Draft laws for this purpose were drawn up and approved in principle by the National Executive in 1996. However introduction of legislation into parliament was delayed by the various crises of 1997-1998. The Department of the Attorney General is now working to introduce enabling legislation into Parliament early in 2001.  The proposed Human Rights Commission would be empowered with a broad range of responsibilities: (1) protection and promotion of human rights; (2) harmonisation of national legislation with international human rights instruments; (3) encouraging ratification of other important human rights instruments; (4) preparing the necessary reports to international human rights monitoring committees; (5) information, education, and awareness on human rights principles and issues.  See also children and women.

ISSUE: LITERACY

GLOBAL AGENDA: Education for All Declaration and Plan of Action (1990) World Summit Declaration and Plan of Action (1990)

PNG RESPONSE: National Literacy Policy, July 2000

SUMMARY OF GOVERNMENT RESPONSE:  The policy responds to the right to literacy enshrined in the PNG Constitution as well as to the Education for All initiative and the World Summit Declaration and global goals.  The policy addresses the needs of persons outside the formal education system (including children who are not in school).  The policy aims to “achieve universal literacy in Pisin, Hiri Motu, or English and in tok ples…” As well as meeting the human development needs of the illiterate, the policy implicitly addresses the issue of culture retention and preservation in the case of languages in danger of extinction.  The policy clarifies the Department of Education to be the lead agency for non-formal education. Within the Department, the National Literacy and Awareness Council is mandated to provide policy direction for literacy development. Literacy work, however, will be undertaken primarily by churches, NGOs, and local level governments but with increased support from provincial and national government.  The Literacy Policy is to be supplemented in due course by a National Language Policy and a National Literacy Plan.

IMPACT OF GOVERNMENT RESPONSES:  Literacy development in PNG dates back more than 125 years. Historically and today, churches have assumed the lead role. It was churches who began and have sustained the process of developing written languages for most of PNG’s many language groups.  Government has repeatedly reiterated the need for a strong focus on literacy since about 1985. However disagreement among literacy advocates about the preferred language(s) of focus have prevented substantial public sector involvement or leadership.  The current policy addresses roles and responsibilities of the various partners in literacy development, strengthens government’s stated commitment to literacy work, and implicitly endorses an emphasis on English, Motu or pisin and tok ples.  The policy sets a goal of 70% national literacy rates by 2010.  The long-term impact of the policy will be closely related to future financial allocations.

ISSUE: NUTRITION

GLOBAL AGENDA: Declaration of the World Food Summit (1996)

PNG RESPONSE: National Nutrition Policy (March 1995)

GOVERNMENT RESPONSE SUMMARY:  The objective of the policy is to reduce and eventually eliminate protein-energy malnutrition, nutritional anaemia, non-communicable diseases, and iodine deficiency.  Specific targets are not set due to an inadequate information base regarding the existing situation.  The focus of intervention is to be community-specific strategies in high prevalence areas as indicated by an assessment of specific causes of malnutrition in these communities.  Primary responsibility for implementing nutrition interventions is borne by provinces, agriculture/livestock/fisheries, health, education, home affairs, and NGOs.  The 1995 policy supersedes an earlier policy promulgated in 1978.

IMPACT OF GOVERNMENT RESPONSES:  Although PNG’s nutrition surveillance system is inadequate, there is little evidence that nutrition status has improved as a result of the policy and related interventions (Annex C).  This lack of progress is possibly due to inadequate attention to underlying structural causes of malnutrition (e.g. poverty and low education levels) combined with deteriorating basic services in many rural areas.  The multi-sectoral nature of malnutrition and the absence of effective inter-sectoral co-ordinating mechanisms also contribute to poor progress.

SEE ALSO:  National Policy on Food Security (March 2000)

ISSUE: POVERTY AND SOCIAL DEVELOPMENT

GLOBAL AGENDA: World Declaration on Social Development (Copenhagen, 1994)

GOVERNMENT RESPONSE: Signatory to the World Declaration (1994)

SUMMARY OF GOVERNMENT RESPONSES:  The Copenhagen Declaration on Social Development (1995) calls on countries to assess poverty and develop poverty alleviation strategies.  With World Bank Assistance, a poverty assessment was conducted in 1996 (analysis completed 1998 and published in 2000).  The assessment found that 37% of the PNG population are “poor” based on the cost of a minimum diet plus a small multipler for other essential cash expenditures. 93% of the poor live in rural areas; most earn their livelihood either from subsistence agriculture/hunting/gathering by smallholder production of tree-crops. Poverty status is closely correlated with limited access to basic services (health, education, transport, and infrastructure). The Highland Region is most affected by poverty; the National Capital District is the least affected by poverty.

IMPACT OF GOVERNMENT RESPONSES:  The formal report on the 1996 poverty assessment was published only in February 2000 (World Bank Report. No. 19584-PNG). Since the assessment was completed, Government, with assistance from the World Bank and AusAid, has established a Poverty Alleviation Programme. This programme has provided financial assistance primarily to NGOs working at grassroots levels. To-date government has not developed a comprehensive policy or poverty alleviation strategy. Poverty however is an underlying theme in virtually all of the government’s plans and policies.

Issue: Population

GLOBAL AGENDA: Declaration and Plan of Action of the International Conference on Population and Development (Cairo, 1994)

PNG RESPONSE: First National Population Policy (approved June 1991) Signatory to the Cairo declaration and plan of action (1994) Second National Population Policy 2000-2010 (approved by the National Executive Council in October 1999)

GOVERNMENT RESPONSE SUMMARY:  The policy responds to the Program of Action emanating from the International Conference on Population and Development (Cairo, 1994).  It aims to reduce the rate of population growth from 2.3% per annum to 2.1% by 2010 and to below 2% by 2020.  It aims to achieve reduced population growth by: (1) reduced fertility and improved reproductive health; (2) reduced mortality and morbidity; (3) rural development which reduces urban migration to Lae and Port Moresby; (4) universal basic education; (5) broad-based population education and integration of population considerations into all aspects of national development planning; (6) increasing opportunities for women; (7) improving population surveillance; (8) strengthening support for the family; (8) strengthening environmental protection mechanisms; (9) expanding employment and livelihood opportunities in both the formal and non-formal employment sectors.

IMPACT OF GOVERNMENT RESPONSE:  Fertility and resulting population growth are declining although the rate of historic decline is inadequate to achieve government’s population targets. The thrust of Governments population policies (1991 and 1995) has been to accelerate this “normal” demographic transition toward lower fertility and lower mortality that emanates from modernisation.  A census was recently completed in 2000 (results to be available in June 2001). This will provide information on the population impact of development during the latter half of the 1990’s. A Demographic and Health Survey planned for 2001 will provide additional information about reproductive health decision-making and the impact of government’s reproductive health services.

ISSUE: SUSTAINABLE DEVELOPMENT AND THE ENVIRONMENT

GLOBAL AGENDA: Rio Declaration on Environment and Development (1992) Agenda 21 Programme for Action on Sustainable Human Development International Climate Change Convention International Bio-diversity Convention Others treaties and conventions too numerous to list here

PNG RESPONSE: Environment and conservation priority goals in the Constitution (1975) First National Environment and Conservation Policy (1976) Sustainable development principles endorsed by National Executive (1990) Signatory to the Rio Declaration on Environment an Development and Agenda 21 Programme for Action on Sustainable Human Development (Rio de Janeiro, 1992) Ratified Climate Change Convention (1992) Ratified Bio-diversity Convention (1993) Waigani Seminar on Environment and Development (1993) Appointment by NEC of a steering committee to prepare a National Sustainable Development Strategy (April 1994; not completed) Ratified a number of other international environmental conventions in the mid-late 1990s.

GOVERNMENT RESPONSE SUMMARY:  Government has ratified most of the international environmental conventions of the 1990’s.  Domestic environmental strategies are contained in four main laws: (1) Environment and Planning Act; (2) Water Resources Act; (3) Environment Contamination Act; and (4) Flora and Fauna Protection Act. There are other supporting acts plus environmental provisions included in legislation governing the various economic development sectors (forestry, agriculture, mining, etc).  Regulatory authority is vested in the Department of Environment and Conservation (from 2000, the Office of Environment and Conservation).  Government will participate in the ‘post-Rio Earth Summit’ planned for 2002; to prepare for this summit, a progress report and forward plan of action will be prepared in 2001. A-98 End Decade Report: PNG, Annex A

IMPACT OF GOVERNMENT RESPONSES:  PNG is home to 7% of the world’s bio-diversity. Conservation is an urgent national and global priority. However, government does not have a current assessment of its conservation programme or strategy. One will be prepared in 2001.

ISSUE: WOMEN

GLOBAL AGENDA: Platform for Action (Beijing, 1995) International Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW)

PNG RESPONSE: National Women’s Policy, 1990 CEDAW ratification, 1994 Granville Declaration of Action, May 1995 PNG Platform of Action, June 1995 Mid-Term Review of the Platform of action, October 1999

GOVERNMENT RESPONSE SUMMARY:  Gender inequality is a cultural reality in most of PNG’s 800 ethnic groups. Although there are ethnic groups where women enjoy equitable or even superior roles, these are exceptions from the norm.  Gender equality is enshrined in the PNG Constitution. Efforts to establish an institutional structure to ensure equitable development pre-date independence.  The PNG Platform for Action (1995) represented PNG’s input into the Beijing Conference and identified actions required to promote the advancement of women in 10 strategic areas: (1) health; (2) education, training, and literacy; (3) economic empowerment and employment; (5) legal and human rights; (6) culture and family; (7) infrastructure (transport, shelter, water and communications); (8) agriculture and fisheries; (9) environment; (10) sustainable development and poverty.  Of the 10 priority areas for action, four were subsequently singled out for priority action: (1) strengthening women’s national machinery; (2) economic empowerment; (3) decision-making and good governance; and (4) integration of gender issues into government planning and administration.  However Government did not officially endorse the Beijing Platform for Action and this had hindered implementation of the National Platform during the period of economic austerity that followed Beijing.

IMPACT OF GOVERNMENT RESPONSE:  The impact of government’s response has been mixed. While progress has been made at an institutional level, the situation of women has remained largely unchanged or in some aspects may have deteriorated (e.g. violence and economic empowerment). A-100 End Decade Report: PNG, Annex A

 There is a National Council of Women and within the Ministry of Home Affairs, a Women’s Division. These bodies are responsible for monitoring the situation of women, co-ordinating women’s initiatives, and implementing CEDAW. The Planning Department has a Gender and Development Unit responsible for mainstreaming gender issues throughout the government. These units are augmented by designated gender focal points in the Departments of Health and Education. Gender has been successfully integrated into the Population Policy, the National Health Plan, the Education Plan, the Small and Medium Term Enterprise Policy, and the National Defence White Paper. xxi A specific project on education of the girl child is being implemented within the Department of Education in co-operation with AusAid. Under provisions of the Revised Organic Act for Provincial and Local Level Governments (1995) there has been an increase in women’s representation in local and provincial governments.  Government and the World Bank have established a women’s credit scheme (1996). Women (continued…)

 In response to CEDAW, a legal literacy awareness project has commenced. Government, however, has not officially designated a task force to oversee implementation of CEDAW, has not undertaken a legal review under CEDAW, has not developed a plan of action for implementing CEDAW, and has not fulfilled its reporting responsibilities under CEDAW.

STATISTICAL ANNEX REFERENCES (INCLUDES BOTH PRIMARY AND SECONDARY DATA SOURCES)

Goal #1, Child Mortality.  National Statistical Office, 1995, Report on the Papua New Guinea Demographic and Health Survey 1991. Port Morseby.  National Statistical Office, 1997, Report on the Papua New Guinea Demographic and Health Survey 1996. Port Morseby

Goal #2, Maternal Mortality.  National Statistical Office, 1997, Report on the Papua New Guinea Demographic and Health Survey 1996. Port Morseby.

Goal #3, Child Malnutrition.  Gibson, J., and Rozelle, S., 1998, “Results of the Household Survey Component of the 1996 Poverty Assessment for Papua New Guinea: A Report Submitted to World Bank Papua New Guinea,” University of Waikato and Stanford University, 1998.

 Heywood, P., Singleton, N., Ross, J., 1988, “Nutritional Status of Young Children: The 1982-83 National Nutrition Survey.” Papua New Guinea Medical Journal, 31:91-101.  Jenkins, C. and Zemel, B., 1990, “Ancient Diversity and Contemporary Change in the Growth Patterns of Papua New Guinea Children,” (Unpublished paper presented to the 59th Annual Meeting of American Association of Physical Anthropologists). American Association of Physical Anthropologists, Miami, USA.  Ministry of Health, 2000, National Health Plan 2001-2010: National Health Profile: Volume III, Part One, Port Moresby.  Mittendorfer, Ellenor and Saweri, Wila, 1999, “Nutrition Country Profile of PNG,” FAO-Apia.

GOALS #4 AND 5, WATER AND SANITATION  Department of Health, 1991, Papua New Guinea National Health Plan, 1991-1995, Port Moresby.  Department of Health, 1998, National Inventory of Health Facilities, Port Moresby.  Gibson, J. and Rozelle, S., 1998, “Results of the Household Survey Component of the 1996 Poverty Assessment for Papua New Guinea,” A paper prepared for the World Bank, PNG, University of Waikato and Stanford University, 1998.  Ministry of Health, 2000, National Health Plan 2001-2010: National Health Profile, Volume III, Part One, Port Moresby.

GOAL #6, BASIC EDUCATION  Gibson, J. and Rozelle, S., 1998, “Results of the Household Survey Component of the 1996 World Bank Poverty Assessment: A Report Prepared for World Bank, PNG,” University of Waikato and Stanford University, 1998.  Josephs, John, 1999, Education For All: The Year 2000 Assessment: PNG Country Report 1999, Department of Education, Port Moresby.  UNICEF and GPNG, 1996, Children, Women, and Families in PNG: A Situation Analysis, Port Moresby.

GOAL #7, ADULT LITERACY  Gibson, J. and Rozelle, S., 1998, “Results of the Household Survey Component of the 1996 World Bank Poverty Assessment: A Report Prepared for World Bank, PNG,” University of Waikato and Stanford University, 1998.  National Statistics Office, 1997, Papua New Guinea Demographic and Health Survey, 1996, Port Moresby.  National Statistics Office, 1994, Report on the 1990 National Population and Household Census in PNG, Port Moresby.  UNICEF and GPNG, 1996, Children, Women, and Families in PNG: A Situation Analysis, Port Moresby.

GOAL #8, DISABILITIES AND CHILDREN IN ESPECIALLY DIFFICULT CIRCUMSTANCES  Working Committee on the Rights of the Child, 1999, Papua New Guinea Initial Report to the UN Committee on the Rights of the Child, Port Moresby.

GOAL #9, HEALTH AND NUTRITION OF GIRLS AND WOMEN  Asian Development Bank, 2000, “A Review of Safe Motherhood Policies and Strategies and their Impact on Women in PNG: A Report from Phase I ADB-RETA Safe Motherhood Project,” June, 2000, Department of Health, Port Moresby.  National Statistics Office, 1997, Papua New Guinea Demographic and Health Survey, 1996, Port Moresby.  Ministry of Health, 2000, National Health Plan 2001-2010: National Health Profile, Volume III, Part One, Port Moresby.  Mittendorfer, Ellenor and Saweri, Wila, 1999, “Nutrition Country Profile of PNG,” FAO-Apia.  Mola, G. and Amoa, A. B., 1998, “The Effects of Anaemia on Pregnancy Outcome,” A paper published in Abstracts of the 34 th Annual Symposium of the Medical Society of PNG, 7-11 September 1998, PNG Medical Society, Port Moresby, PNG.  Preble, Elizabeth, 2000, “Prevention of Mother-to-Child Transmission of HIV in PNG: An Assessment and Recommendations,” 2000, UNICEF-PNG.  UNICEF and GPNG, 1996, Children, Women, and Families in PNG: A Situation Analysis, Port Moresby.

GOAL #10, CONTRACEPTION  National Statistics Office, 1994, Papua New Guinea Demographic and Health Survey, 1991, Port Moreby.  National Statistics Office, 1997, Papua New Guinea Demographic and Health Survey, 1996, Port Moresby.  Ministry of Health, 2000, National Health Plan 2001-2010: National Health Profile, Volume III, Part One, Port Moresby.

GOAL #11, ANTENATAL AND OBSTETRICS CARE  Asian Development Bank, 2000, “A Review of Safe Motherhood Policies and Strategies and their Impact on Women in PNG: A Report from Phase I ADB-RETA Safe Motherhood Project,” June, 2000, Department of Health, Port Moresby.  Department of Health, 1996, Family Health Indicators 1990-1995, Port Moresby.  National Statistics Office, 1997, Papua New Guinea Demographic and Health Survey, 1996, Port Moresby.  Ministry of Health, 2000, National Health Plan 2001-2010: National Health Profile, Volume III, Part One, Port Moresby.  UNICEF and GPNG, 1996, Children, Women, and Families in PNG: A Situation Analysis, Port Moresby.

GOAL #12, LOW BIRTH WEIGHT  Ministry of Health, 2000, National Health Plan 2001-2010: National Health Profile, Volume III, Part One, Port Moresby.

GOAL #13, ANAEMIA  Asian Development Bank, 2000, “A Review of Safe Motherhood Policies and Strategies and their Impact on Women in PNG: A Report from Phase I ADB-RETA Safe Motherhood Project,” June, 2000, Department of Health, Port Moresby.  Mittendorfer, Ellenor and Saweri, Wila, 1999, “Nutrition Country Profile of PNG,” FAO-Apia. A-103 End Decade Report: PNG, Annex A

 Mola, G. and Amoa, A. B., 1998, “The Effects of Anaemia on Pregnancy Outcome,” A paper published in Abstracts of the 34 th Annual Symposium of the Medical Society of PNG, 7-11 September 1998, PNG Medical Society, Port Moresby, PNG.  UNICEF and GPNG, 1996, Children, Women, and Families in PNG: A Situation Analysis, Port Moresby.

GOAL #14, IODINE DEFICIENCY  Mittendorfer, Ellenor and Saweri, Wila, 1999, “Nutrition Country Profile of PNG,” FAO-Apia.  National Planning Office, 2000, “Draft End Decade Report to UNICEF,” December 2000, Port Moresby.  UNICEF and GPNG, 1996, Children, Women, and Families in PNG: A Situation Analysis, Port Moresby.

GOAL #15, VITAMIN A DEFICIENCY  Friesen, H., et.al., 1998, “Infant Feeding Practices in PNG,” Annals of Tropical Pediatrics, 18:209-215.  Genton, B., et.al., “Vitamin A Status and Malaria Infection, Morbidity, and Immunicty in a Highly Endemic Area of PNG,” XVIIVACG Meeting Abstract Form.  Mittendorfer, Ellenor and Saweri, Wila, 1999, “Nutrition Country Profile of PNG,” FAO-Apia  National Planning Office, 2000, Draft End Decade Report to UNICEF, December 2000, Port Moresby.

GOAL #16, BREASTFEEDING  Ministry of Health, 2000, National Health Plan 2001-2010: National Health Profile, Volume III, Part One, Port Moresby.  National Planning Office, 2000, Draft End Decade Report to UNICEF, December 2000, Port Moresby.  Preble, Elizabeth, 2000, “Prevention of Mother-to-Child Transmission of HIV in PNG: An Assessment and Recommendations,” 2000, UNICEF-PNG.

Goal #17, Growth Monitoring  Department of Health, 1996, Family Health Indicators 1990-1995, Port Moresby.  PNG-UNICEF, 2000, “Mid-Term Review 2000,” October, 2000, Port Moresby.  UNICEF and GPNG, 1996, Children, Women, and Families in PNG: A Situation Analysis, Port Moresby.

GOAL 18, FOOD SECURITY  Department of Agriculture and Livestock, 2000, Papua New Guinea National Food Security Policy, May, 2000, Port Moresby.  Mittendorfer, Ellenor and Saweri, Wila, 1999, “Nutrition Country Profile of PNG,” FAO-Apia.

Goals 19-22, Immunization  Department of Health, 1991, PNG National Health Plan 1991-1995, Port Moresby.  Ministry of Health, 2000, National Health Plan 2001-2010: National Health Profile, Volume III, Part One, Port Moresby.  National Planning Office, 2000, “Draft End Decade Report to UNICEF,” December 2000, Port Moresby.

Goal 23, Diarrhoea  Ministry of Health, 2000, National Health Plan 2001-2010: National Health Profile, Volume III, Part One, Port Moresby.  National Planning Office, 2000, “Draft End Decade Report to UNICEF,” December 2000, Port Moresby.  National Statistics Office, 1997, Papua New Guinea Demographic and Health Survey, 1996, Port Moresby.

GOAL 24, ACUTE RESPIRATORY INFECTIONS  Ministry of Health, 2000, National Health Plan 2001-2010: National Health Profile, Volume III, Part One, Port Moresby.  National Statistics Office, 1997, Papua New Guinea Demographic and Health Survey, 1996, Port Moresby.

Goal 25, Guinea Worm  Not Applicable

GOAL 26, EARLY CHILDHOOD DEVELOPMENT ACTIVITIES

OTHER INDICATORS OF CHILDREN’S RIGHTS  Lalicon, Carlito, 2000, “Addressing the Challenge of Unregistered Children in PNG: A Paper Prepared for UNICEF PNG,” October 2000, Port Moresby.  Working Committee on the Rights of the Child, 1999, “Initial Report to the UN Committee on the Rights of the Child,” November, 1999, Port Moresby (page 46).

OTHER INDICATORS OF IMCI  . National Statistics Office, 1997, Papua New Guinea Demographic and Health Survey, 1996, Port Moresby.

OTHER INDICATORS OF HIV/AIDS  National Statistics Office, 1997, Papua New Guinea Demographic and Health Survey, 1996, Port Moresby.  UNICEF and GPNG, 1996, Children, Women, and Families in PNG: A Situation Analysis, Port Moresby.

A-106 i Note that some outlying islands are affected by rising sea levels and shifting earth plates. Plans are in progress to relocate some residents of outlying islands in the New Britain group. ii Preble, Elizabeth, “Prevention of Mother-to-Child Transmission of HIV in Papua New Guinea: An Assessment and Recommendations,” UNICEF-PNG, Port Moresby, October 2000, page 9. iii Working Committee on the Rights of the Child, “Initial Report to the UN on Implementation of the CRC in PNG,” Port Moresby, November 1999, page 72. iv Department of Education, “The State of Education in Papua New Guinea,” Port Moresby, March 2000, page 6. v Government of Papua New Guinea and UNDP, “Sustainable Human Development 1999,”Port Moresby, 1999, (Page 12). vi For the purposes of this report, the term NGO refers to organizations that are legally constituted as not-for-profit corporations and have some elements of a modern organisation (e.g. board of management, bylaws or constitution, written records, bank transactions and often one or more paid staff). A community-based organisation is not legally constituted and often has only a customary organisational structure. vii Pigbel is a viral disease that affects children after they have eaten pork; it is particularly prevalent and virulentt in the Highlands Region but has also been recognised in other areas of the world. viii ODA estimates are derived from the 2000 and 2001 government budgets. ix Gibson, John, World Bank poverty consultant, information provided in an oral presentation at the First Solomon Islands Poverty Seminar, Honiara, March 2000. x Mittendorfer, Ellenor and Saweri, Wila, “Nutrition Country Profile of Papua New Guinea,” FAO, 1999, page 8. xi World Bank, “Papua New Guinea: Poverty and Access to Public Services,” Washington DC, 2000, pages 13-15. xii Government of PNG, “Country Report: Report on Implementation of the Global Platform and the National Platform for Action (for Women), October 1999, pages 13-17. xiii Abrishamien, N., “ xiv Working Committee on the Rights of the Child, “Initial Report to the UN Committee on the Rights of the Child, November 1999, Port Moresby, page 72. xv Gibson, John and Rozelle, Scott, “Results of the 1996 Poverty Assessment for Papua New Guinea,” University of Waikato and Stanford University, May 1998, page 95. xvi (1) Josephs, J. “Education for All: The Year 2000 Assessment: PNG Country Report 1999,” Port Moresby, 1999, pages 34-35. (2) Department of Education, “Education for All Assessment 2000: PNG Country Report,” pages 45-47. xvii National Department of Health, “Mid-Term Review of the 1996-2000 Health Plan,” Port Moresby, June 1998. xviii “Country Report on Implementation of the Global Platform and the National Platform for Action (for Women),” Government of Papua New Guinea, October 1999, pages 20-21. xix UPNG, “Leadership Forum for Children: Draft Proceedings,” December 2000. xx Although PNG ratified CEDAW in 1994, it has not prepared the initial implementation report mandated in that convention. xxi “PNG Country Report on Implementation of the Global Platform and the National Platform for Action, 1995-2005,” Port Moresby, October 1999, (page 6).