PnG Article: Incentivising maternity and newborn care in Simbu province

Article was originally written for PnG paper

Professor Glen Mola, Head of Women’s health, Obstetrics & Gynaecology at SMHS-UPNG

I have spent a lot of the 5o years of my professional life trying to improve health outcomes for women and their newborns.  Research over the last 30 years has been very clear and that is supervised birth in a health facility and family planning are the two things that make the difference between life and death for women and their babies.

A supervised birth (even in a basic rural health centre) can prevent maternal death from the commonest causes (haemorrhage – bleeding, and infection getting into the birth passage. And identification of other complications early and appropriate referral to the provincial hospital can prevent most of the other maternal deaths.  Babies are also saved by supervised birth.  If the baby does not breath and cry within 1 minute of birth, then the nurse can start bag and mask resuscitation (gipim win long baby) and save its life in most cases.  There is no way that these life-saving things can be done if the woman has her baby in the house: the baby will not be saved even if the mother’s house is next door to the health centre, it will be too late.

And family planning saves both mother’s lives (because you can’t die from a pregnancy complication if you do not get pregnant!), and spacing pregnancies for at least 3 years gives each baby a much better start in life (exclusive breast feeding for the first 6 months and then extended to at least 2 years).  And a supervised birth is an opportunity to assist the mother with family planning too.

I have watched the supervised birth proportion static at 40% for the past 40 years.  Meanwhile, we have trained more nurses and midwives, we have upskilled CHWs to provide quality maternal and newborn care.  We have built new maternity and birthing units in rural health facilities (the maternity units at Kompiam district hospital (Enga) and Wangoi (South Chuave) have better facilities for mothers than most provincial hospitals.  But women are still not coming to have a supervised birth in these rural health facilities.  No more than 10% of pregnant women in the catchment areas of most rural health centres come to the local health facility to get a supervised birth; they either go to the provincial hospital (bypassing the rural health facility) or stay at home to deliver in the village.

In 2013 we decided to try a new strategy, and that is to incentivize mothers (and their husbands) to come to the local health facility for supervised birth.  We got this idea from Cambodia where an incentivization program increased supervised births from 35% to 70% in 5 years.  Dr Barry Kirby and I started an incentivization program in 15 rural health facilities in Milne Bay province; this has resulted in a 80% increase in supervised births.  This year we decided to extend the program to Simbu province and see if an incentivization program would have similar results there.

Dr Barry Kirby, Sr Kila (Emergency Nurse for The Hands Of Rescue), my son (Dr David Sinowai), catholic health secretary Sr Elizabeth Koae, Simbu family health services coordinator Sr Lina Kua and I spent last week going around Simbu province to initiate an incentivize program.  There was no government money to do this, but the government has spent money on upskilling CHWs and built a number of very nice labor wards, so we decided to use our own resources to go the ‘extra mile’ get women to come and use them. We are starting the program in Wangoi, Gogme and Bogo health centres.

The incentive package includes

1. A ‘baby gift bundle’ for each mother who comes to have a supervised birth; this consists of about K100 worth of baby things (so the mother does not have to stress herself about getting all the requirements for birth – ie nappies, baby-blanket, towel, soap, moddess, cap and clothes for baby, safety pins etc.), clean clothes for the mother and a bush knife and sharpener file for Dad.
2. Food (rice and tin-fish) for mothers while they are waiting to give birth, and cash money (K100 in coins) so that the nurses can buy fresh food for the mothers in the local market, (because one of the main reasons that women don’t come to have a supervised is that there is no food in the rural health centres)
3. Accommodation for mothers to ‘wait karim’. We are building a mother’s waiting house and cook-haus at Bogo HC and a ‘haus man’ and cook-haus at Wangoi.
4. We have also installed solar lights in to these health centres so that nurses don’t have to give birthing care with only the aid of their mobile phone torches.

I hear that even one week down the track that more mothers are coming to have a supervised birth in our Simbu province pilot health facilities; but time will tell whether there is a lasting impact.  The Simbu provincial health office (Mr Jerry Kubu and his team) have said that they will try and incorporate this incentivization program into their budget for next year if it works well.

Figure 1. Marian, first mother to receive baby bundle at Gogome health centre with nurse Mary and Prof Glen Mola

Figure 2. Prof Mola & Dr Barry Kirby opening the new maternity wing at Wangoi HC

Figure 3 Wangoi crowd rejoicing at the opening of the new maternity wing at the HC

Figure 4 Remote Bogo HC where a maternity waiting house will be built so that mothers can come and wait for their labor to begin