Impact Data - Women and Children's Health (WCH) Project
Date
The Australian Agency for International Development (AusAID) funded the Papua New Guinea Women and Children's Health (WCH) Project between July 1998 and December 2004. The WCH Project aimed to improve women and children's health though enhanced quality and coverage of rural health services throughout all 19 provinces and the national capital district of PNG. Key health-service activities included in-service training for district health workers, and improvements to the cold chain vaccine supply system. Community activities sought to increase support for the health of women and children through behaviour and attitude changes in relation to sanitation, hygiene, and housing. Village health volunteers (VHVs) who serve as health educators in their community were identified as the intended audience, with activities focused on strengthening and expanding existing training programmes. Key indicators of a healthy lifestyle were incorporated into 2 visual tools for monitoring community and family progress (e.g. "healthy community" and "healthy family").
Methodologies
This evaluation was conducted 2 years after completion of formal project between March and September 2006. The rapid assessment, response, and evaluation (RARE) process was used to collect, synthesise, and analyse qualitative data. Significant stories of community activities and interaction with the health system were collected as a culturally appropriate way of relating experience to knowledge.
The evaluation covered 10 of the 20 provinces, all 4 regions, 19 of the 89 districts (21%), 44 rural health facilities (8%), and 93 isolated communities that were recipients of WCH project input. A multi-level targeted sampling technique was used to identify communities and rural health facilities within sampled provinces and districts. One district per province and 2 health facilities within each district were sampled. Two communities in the catchment area of each health facility were sampled. This model was replicated in each province sampled. Selection was based on likely variability of uptake.
Data were collected through 175 interviews, 77 community-level group discussions, 15 site visits, opportunistic observations of behaviours, and health record audits. Demonstrated outcomes for this study were categorised according to the amount of change in the community that could be attributed to WCH project community interventions. The term "successful" was assigned to a community, based on the PNG healthy islands framework criteria for a "healthy community" setting. Each of the 73 communities was assessed according to the degree to which it met the minimum requirements. (See Table 1 on page 8 of the report.)
The evaluation covered 10 of the 20 provinces, all 4 regions, 19 of the 89 districts (21%), 44 rural health facilities (8%), and 93 isolated communities that were recipients of WCH project input. A multi-level targeted sampling technique was used to identify communities and rural health facilities within sampled provinces and districts. One district per province and 2 health facilities within each district were sampled. Two communities in the catchment area of each health facility were sampled. This model was replicated in each province sampled. Selection was based on likely variability of uptake.
Data were collected through 175 interviews, 77 community-level group discussions, 15 site visits, opportunistic observations of behaviours, and health record audits. Demonstrated outcomes for this study were categorised according to the amount of change in the community that could be attributed to WCH project community interventions. The term "successful" was assigned to a community, based on the PNG healthy islands framework criteria for a "healthy community" setting. Each of the 73 communities was assessed according to the degree to which it met the minimum requirements. (See Table 1 on page 8 of the report.)
Knowledge Shifts
Previously, most villagers reportedly believed that sanguma (sorcery) caused illness. Increased knowledge and understanding of the "real" (root) cause of illness motivated behaviour changes as individuals realised that unhealthy practices were making them sick.
Individuals in "successful" villages made statements such as: "Now we enjoy eating often meals with new foods such as chicken, fish, rabbit, beans, peanuts, carrots and cabbage....we now understand it is important to eat a lot of different kinds of foods to prevent illness."
Individuals in "successful" villages made statements such as: "Now we enjoy eating often meals with new foods such as chicken, fish, rabbit, beans, peanuts, carrots and cabbage....we now understand it is important to eat a lot of different kinds of foods to prevent illness."
Practices
Individuals reported experiencing benefits from simple, small, and inexpensive changes (such as improved sanitation and waste disposal practices) that motivated changing traditional ways. Examples:
Observations of the numbers of clients seeking curative treatments at aid posts in one district demonstrated the impact of community health education in reducing illness and health workers' workload. These health workers remarked how this had freed them from the clinical tasks associated with treatment to provide health education and assist communities in promoting healthier lifestyle practices.
- People were using a pit latrine rather than defaecating in the bush behind the house, in the garden, or on the beach.
- Pigs were removed from areas of human habitation and fenced in an enclosure.
- Some communities had relocated to allow each family space to build a new house with improved ventilation, a pit latrine, and small vegetable garden.
- One community's resourcefulness provided water for household purposes by digging a drain and allowing nearby stream water to flow alongside the road through the village.
- Some families built raised platforms as a drying rack for cooking and eating utensils, protecting them from contamination by dirt, flies, and animals.
- "Successful" communities often carved out an access road to the village, erected fences around each family's allotment, and planted colourful shrubs along the fence line.
Observations of the numbers of clients seeking curative treatments at aid posts in one district demonstrated the impact of community health education in reducing illness and health workers' workload. These health workers remarked how this had freed them from the clinical tasks associated with treatment to provide health education and assist communities in promoting healthier lifestyle practices.
Attitudes
Individuals reported: "Before our cultural beliefs restricted children and pregnant women from eating certain foods. Now they can eat any kind of food and we have seen the changes [in them] and they are now healthy."
Increased respect for authority among young people has reduced social problems such as criminal offences and domestic violence.
Increased respect for authority among young people has reduced social problems such as criminal offences and domestic violence.
Increased Discussion of Development Issues
Participants in large community meetings described how improved relationships had reduced social problems caused by using marijuana and alcohol, and by smoking.
Other Impacts
"Successful" villages identified changes leading to improved physical health with unintended consequences in other aspects of life. Informants reported fewer bouts of illness and increased strength and energy for gardening. Extra produce had increased the family's income giving freedom to increase food intake, eat a variety of foods, and purchase store goods, clothing, and other basic necessities. Increased income provided money for children's education. Individuals reported: "Our children are healthier and better nourished which helped them improve their learning ability and so we are seeing them go on to higher grades in school..."
Source
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