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Evaluation of a program to improve the interaction between community and health systems in Papua New Guinea : its impact on improved maternal and child health

Ashwell, Helen Elizabeth Scott (2008). Evaluation of a program to improve the interaction between community and health systems in Papua New Guinea : its impact on improved maternal and child health. PhD Thesis, Charles Darwin University.

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Author Ashwell, Helen Elizabeth Scott
Title Evaluation of a program to improve the interaction between community and health systems in Papua New Guinea : its impact on improved maternal and child health
Institution Charles Darwin University
Publication Date 2008
Thesis Type PhD
Subjects 1199 - Other Medical and Health Sciences
1117 - Public Health and Health Services
Abstract The Papua New Guinea Women and Children’s Health Project sought to improve the health of women and children between 1998 and 2004. Community development and health promotion interventions sought to increase community support for the health of women and children. This research investigated the impact of the interventions on community support for the health of women and children. Green & Kreuter’s (2005) PRECEDE-PROCEED model of health program planning was applied retrospectively to critique the design, implementation, and impact evaluation processes. Two years after completion of formal Project activities an outcome evaluation investigated the impact. The study identified how the community action participation and village health volunteer program activities influenced improved interaction between the community and rural health workers. The study identified key factors that influenced the success or failure of that interaction on improved maternal and child health. The outcome evaluation applied a multi-methods approach to assess the interaction of the community and health workers, and the community’s use of health services. Data were collected from 175 key stakeholders (national, provincial, district, and village) and 93 communities across 10 provinces. Methods used were interviews, group discussions, site visit observations, documents and health record audit. AusAID financed field work activities. Qualitative data suggested healthier lifestyle practices had contributed to improved physical health, and social and economic well-being. New health knowledge initiated attitude and behaviour changes, which led to improvements in environment, sanitation and hygiene practices. Changes in one community positively influenced nearby communities. Key factors that influenced success were a health motivated individual as the catalyst for change; empowered leadership through new community governance structure; effective visual tools; and village health volunteers linking the community and rural health workers. Failure was attributed to poor understanding of community development; limited sharing of information; a ‘top-down’ approach; and weak community leadership. The study identified anomalies in health information collection processes and lack of village-level baseline data to support claims of improved community health status. Gross maternal and child health statistical indicators and incidence of illness failed to show any significant change as data cannot be disaggregated for village-level outcomes. Green & Kreuter’s (2005) PRECEDE-PROCEED model fails to allow for ‘inhibiting factors’ as part of the educational and ecological assessment planning phase. Inhibiting factors of pre-defined objectives and contractually obligated outputs in a donor funded business model negatively influenced Project design and outcomes. Despite the context, this research confirmed the Project interventions improved the interaction between the community and health system, and influenced improved use of maternal child health services. Therefore, sustainable self-reliance in health can be achieved through community led and maintained activity.


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