Today in Port Moresby a gathering of experts will meet at Papua New Guinea’s 2012 National Malaria Summit to discuss the country’s plan to combat the life-threatening disease. Hosted by the National Department of Health, the summit will bring together key actors involved in the delivery of the PNG Malaria Control Program, allowing clinicians, public health practitioners and researchers the opportunity to provide updates on provincial progress against the disease and to revise up-to-date prevention and treatment strategies.
One of the organisations involved in the summit will be the Papua New Guinea Institute for Medical Research (PNGIMR), PNG’s leading medical scientific research institute. PNGIMR drives a strong PNG based research agenda, which identifies appropriate solutions for scientifically-informed responses to malaria in the Pacific region. In its most recent reports PNGIMR has urged funders to seriously consider the challenging setting that PNG provides in implementing malaria treatment and prevention programs.
Indeed, malaria continues to be a significant public health challenge in Papua New Guinea. The disease is the country’s most common outpatient diagnosis, with the World Health Organisation reporting approximately 1.36 million cases per year. This makes malarial infection the second-highest leading reason for hospital admission. Approximately 90% of the population is at risk of infection with some 800 malaria-related deaths in 2011; most of these being children under the age of five.
Participants at today’s National Malaria Summit will include the Oil Search Health Foundation, Rotarians Against Malaria and Population Services International. In partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria, these organisations have been instrumental in assisting the Papua New Guinea National Department of Health in adopting of the PNG Malaria Control Program. The collaborative nature of the program itself has achieved impressive results, and since 2007 has seen over 5.5 million insecticide treated bed nets distributed and resulted in a reduction in the incidence of malarial infections within the community from 13% in 2009 to 6.5% in 2011 (PNGIMR, forthcoming).
The address of malaria as a significant public health burden in Papua New Guinea and other countries in the Asia-Pacific region will also form the basis of high-level discussions in the upcoming 2012 International Malaria Summit, which will be held in Sydney and hosted by AusAID in late October this year.
This is a guest post from Anna Maalsen, Public Health Management Advisor at the National Department of Health in Port Morseby, Papua New Guinea.
Walking into the Public Health Division of the National Department of Health in Port Moresby, Papua New Guinea, is akin to entering the central nervous system of the country’s health system. Here a group of committed public servants, technical advisers and international partners tap away at their computers planning and coordinating the response to the country’s priority diseases. It is challenging work, but the biggest challenge still remains in service delivery and ensuring that sufficient financial resources are made available to implement programs to scale.
The initial grants disbursed by the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2004, heralded a new opportunity to address both the financial and service delivery issues, pumping resources into diseases long forgotten after the dismantling of the public health programmes in the early 1980’s. It offered the chance to reverse the increasing rates of malaria, tuberculosis, and address the emerging threat of HIV and AIDS. Significant gains were made during this period, the National Department of Health (NDOH) as the Principle Recipient (PR) distributed over 2 million treated bed nets, introduced the Fixed Dose Combination Treatment and Directly Observed Treatment Strategy for TB, and introduced Anti-Retroviral Treatment at 55 clinics and scaled up HIV counselling and testing in over 400 centres across the country.
However, the increasing burden of Global Fund grant management began to place great stress on the already fragile internal systems, which were not designed to manage such large amounts of funds. A complex period in 2011 with internal restructuring and insufficient capacity to manage the grants, the Secretary of Health at the time, made a tough but courageous decision to relinquish the Global Fund grant management. This would allow for the Department of Health to focus on its core business: technical support, policy and leadership, and give way for future grants to managed by organisations that routinely manage. Dr Paison Dakulala, the Deputy Secretary commented to the CCM at the time of decision “the Global Fund is like a super tanker pulling up to a small wooden wharf, what we need is the super tanker to go offshore for a time to give us the space to build a concrete wharf in order to unload the cargo.”
Despite this, an opportunity to change the way of doing business for the Department emerged and the Secretary endorsed a progressive partnership model, which would see that the NDOH would very much remain the lead on the grants both on the technical and programmatic sides, but effectively outsource the financial and grant management aspects. This aligns very closely to the National Health Plan 2011-2020, the most clearly articulated plan for the Health System in over 30 years, and links directly to the Key Result Area 2: Strengthen partnerships and coordination with stakeholders. In 2012, the Secretary of Health, Mr Pascoe Kase signed a Memorandum of Agreements with both the Oil Search Health Foundation and World Vision International, which sets out the process for the new way of doing business. Secretary Kase states that best thing about the new arrangement is “that the NDOH can have confidence that critical activities are delivered in a timely manner with partners that we can trust who have a demonstrated track record. Thus leaving the dedicated staff at the NDOH to get on do what they do best, providing the technical and policy leadership, along with planning and coordinating the response to these priority diseases.”
This is a guest post from Amanda Allen-Toland, Program Manager at the Asia Pacific Business Coalition on AIDS and Elizabeth Reid, Serendipity Educational Endowment Fund Trustee.
Before the arrival of HIV in Papua New Guinea, the extended family provided a sound support base to care for the children of family members who passed away. However due to the large number of people living with HIV and AIDS in PNG, estimated to be 60,000 people, extended family support mechanisms are struggling to cope with the rising numbers of children that need care and support following the death of their parents or primary caregiver.
There has been little focus on the children of the HIV epidemic. There is little understanding of their situation and few people are working with them. Some of these children are infected, all are affected. They face many problems. One overwhelming problem is the likely loss of an education, which has serious ramifications for their futures. Children whose parents are infected are often lost to school long before their parents die: tension in the family, unaffordable school fees, family breakdown, a parent leaves or dies, they are stripped of their inheritance, of land or home, and more.
In 2008, as a young Australian entrepreneur, Craig McMahon donated $250,000 to the Asia Pacific Business Coalition on AIDS (APBCA). APBCA immediately consulted with its national affiliate, the PNG Business Coalition Against HIV and AIDS (BAHA) and following further consultations, realised the gap in support for children made vulnerable by the epidemic. Shortly after, the Serendipity Educational Endowment Fund was established with the original $250,000 donation and has now grown and receives funds from the Myer Foundation and the PNG Sustainable Development Fund.
The Serendipity Fund supports families all over PNG by providing funds to enable children affected by HIV to complete their education. The program covers the cost of schools books, uniforms and fees. The average cost of a child’s education in PNG is $3,000. Without a parent or guardian to cover these costs, most leave school and work to contribute to the extended family household.
Australian film-director Kasimir Burgess has made a short film about the Serendipity Fund, called “Hope for Life”. The film provides a rare opportunity to hear the stories of children whose lives have been affected by HIV.
The Serendipity Educational Endowment Fund provides funding for a quality, sustainable education to children living in the region whose lives have been affected by AIDS. Serendipity benefits children who have lost one or both parents to AIDS, children whose parents are living with HIV and the children of families providing support. This program is currently operating in PNG, where approximately 200 children are receiving financial support to continue their education.
For more information about the Serendipity Fund and how to contribute, go to www.apbca.com
Beginning tomorrow, a regional symposium will call upon the expertise of academics, activists, policy makers, and practitioners with an interest in HIV, sexuality, and human rights in the Pacific to highlight ground-breaking social research on the HIV & AIDS epidemic in Papua New Guinea. Between 11-13 July, the Sexualities, sexual rights, and HIV in Papua New Guinea and the Pacific Symposium at the Australian National University in Canberra will host a gathering of researchers and policy makers from the Pacific region. Pacific Friends is pleased to announce its participation in the symposium, where we will be able to engage with the core social issues surrounding HIV treatment, prevention and care in Papua New Guinea.
A new $8 million plan has been announced to strengthen PNG’s national health capacities in addressing the burden of Tuberculosis (TB). The new AusAID funded program will enable strengthening of the support and facilities of remote clinics in Daru and along the coastal villages of the Western Province of Papua New Guinea.
The strengthening of these national PNG authorities will be assisted by the work of bodies such as World Vision PNG; which are already delivering positive results in the area of treating and monitoring existing TB cases. Following a recent handover from the Queensland and the Australian Federal Governments, concern has been raised that that the closure of Australian clinics in the Torres Strait at the end of this month may be premature and that there may be no guarantee that services in Daru and surroundings will be accessed by PNG nationals.
Having advocated on the issue of tuberculosis for some years, grassroots anti-poverty organisation RESULTS International (Australia) hopes that success in this initiative will help to generate improved management of TB across the country.
National Manager, Maree Nutt, said:
RESULTS members will continue to monitor the situation to ensure that communication pathways are open between PNG clinicians and those who have been managing TB in the Torres Strait, to facilitate a sharing of skills, advice and experience. [These] improved hospital facilities, faster diagnostic tools (such as Gene Xpert) and health workers to supervise the long course of drug treatment are all essential for treating and minimizing the threat of TB and drug resistant TB.
The strengthening of national services will enable clients to better access to life-saving TB treatment as well as being a significant safeguard against the threat of drug-resistant TB to the Australian border. The issue of TB and drug resistant TB is not only a concern for the Western Province, but also for PNG more broadly. Recently ABC’s 7:30 Report warned of the threat of drug-resistant TB to Australian borders. Now, with improved health care facilities and increased capacity to treat TB, existing cases will be effectively managed on the PNG side of the border. Moreover, this will prevent PNG citizens from accessing treatment across the border, which is likely to result in irregular treatment and the development of drug-resistant forms of the disease.
As key organisation managing TB programs in PNG, World Vision PNG is one of the principal recipients of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Over the last three years of the implementation of their DOTS project, World Vision has seen an improvement in the detections of TB from 21% to 81% of cases. The World Vision DOTS program coincides with the National TB Program, and provides feedback to the National Department of Health through provincial offices. World Vision PNG remains optimistic on the issue of integrating new patients into national programs in the effort to fight TB and its drug-resistant forms. World Vision PNG is mobilising its Stop TB Program in the Western Provinces, a program designed to forge a partnership between World Vision, AusAID, the Western Province Health Division and the National TB Program and utilise the skills and resources of each agency and maximize these for the benefit of the Western Province people so that TB services and case management can be dramatically improved in the region.
World Vision commented:
World Vision recognises that multi drug resistant TB on Australia’s border poses a major risk of the disease spreading further. However, like all issues it is important to locate these threats within a broader context. TB is clearly not a disease that is limited by provincial or international boundaries. When reviewing the broader TB landscape in PNG it is important to note that Western Province comprises just 1.7 percent of the total cases, with more than a third of the cases coming form Port Moresby. With this in mind it is important that we continue to push for nation-wide strengthening of TB services so that an inconsistency of care, such as that experienced on the Western Province Border, is not repeated.
World Vision views its work in Western Province as a high priority and is critically aware of how the often negative political debate around this cross border issue has the potential to have real ramifications on patient well being. From World Vision’s experience in managing TB across the country we know that if patients have to travel to receive TB treatment their likelihood of defaulting (stopping medication prematurely) increases significantly and the rise of drug resistant cases is only a matter of time. Therefore, with this injection of funding (AusAID), we believe that treating Western Province TB patients on the PNG side of the border, is not only within our technical capacity but also the only just way of providing TB care to these patients – the only way that is likely to provide increased cure rates.
The work of World Vision PNG and other PNG authorities remains a key force in identifying and treating TB in the Pacific region, and with the announced $8 million plan to better address the burden of TB in PNG, it will reduce the threat of the disease crossing the Australian border.
Global Health News
Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria is a high-level advocacy organisation which seeks to mobilise regional awareness of the serious threat posed by HIV & AIDS, tuberculosis and malaria to societies and economies in the Pacific. In pursuing its goals Pacific Friends has a specific interest in highlighting the need to protect the rights of women and children in the Pacific.