Papua New Guinea

PSI/Papua New Guinea estimates that in 2015, its products and services helped avert 6,875 DALYs, including, by health area:

• 5,428 Malaria DALYs
• 797 HIV DALYs
• 410 FP DALYs
• 226 MNCH DALYs
• 14 WASH DALYs

PSI/Papua New Guinea’s family planning programs also provided 2,555 couple-years protection. 

Malaria

The entire population of Papua New Guinea (PNG)  is considered at risk of malaria, with 94% living in high risk or high transmission areas.^[1] In fact PNG has one of the highest transmission rates in the Western Pacific region, accounting for 71% of reported malaria cases and 77% of all malaria deaths.^[1]  Each year, there are an estimated 2.2 million suspected malaria cases^[2] and nearly 300 deaths.

Children under five years old, pregnant women and people living with HIV and AIDS inequitably carry this burden. In addition, malaria interventions are exceedingly challenging in PNG due to the presence of all four malaria parasite species. Since November 2009, PSI/PNG has been the principal recipient from The Global Fund to Fight AIDS, Tuberculosis and Malaria working to complement the PNG government’s efforts in malaria control. Through this project, PSI/PNG works to strengthen political commitment for malaria control and maximize access to prompt quality malaria diagnosis and appropriate treatment. Activities include:

• Developing a network of partners (government offices, faith-based organizations and NGOs) to facilitate consistent messaging for behavior change communication around malaria prevention and treatment.
• Producing low-literacy instructions for the government’s first-line malaria treatment to facilitate treatment compliance (particularly among children under five years old).
• Deploying community mobilization outreach officers to conduct health education sessions in communities to increase consistent and correct use of preventative methods and testing and treatment behaviors.
• Develop and implement a national communications strategy to include interpersonal communication and mass media from 2009 to 2014.
• Implement the Home-Based Malaria Management Program (HMM) in three provinces using a community based distribution model

^[1] National Malaria Control Strategic Plan 2014-2018

^[2] National Malaria Control Strategic Plan 2014-2018

^[1] World Malaria Report 2015

Home Based Management of Malaria

In 2012, PSI rolled out the HMM Program in partnership with the National Department of Health (NDoH), Save the Children and the Burnet Institute.

Due to the country’s geography and poor infrastructure, access to care remains a central challenge for those living in rural and remote areas. The HMM program exists to bridge this gap.

The HMM program extends access to malaria diagnosis and treatment beyond aid posts and health facilities using a network of volunteer community-based distributors (CBDs) that live in the most rural areas of the three implementing provinces: East Sepik Province (managed by Save the Children) East New Britain Province (managed by the Burnet Institute) and in Sandaun Province where PSI directly implements.

The program allows for the delivery of lifesaving malaria interventions for communities and those most at risk, including children under five. Ensuring this group has access to early diagnosis and treatment of simple malaria contributes to an overall reduction in child mortality. Implemented in communities outside the reach of existing health facilities, HMM is a key national strategy to expand access to malaria testing and treatment beyond aid posts and health facilities.

Since its launch in 2012, PSI’s HMM malaria control program has achieved the following results:

• Expanded to cover three provinces (East New Britain, East and West Sepik) to reach a population of approximately 616,559 in high risk areas ensuring access to rapid diagnostic tests (RDTs) and artemisinin-based combination therapies (ACTs).
• Tested more than 80,000 people using socially marketed RDTs and treated about 15,000 with Mala 1 (ACT – AL).
• Trained over 2,500 community-based distributors on the diagnosis and treatment of uncomplicated malaria and to administer RDTs, provide ACTs when appropriate, and report results to national monitoring and evaluation systems.

HIV/AIDS

PNG has the highest incidence rates of HIV in the Pacific region. High incidences of sexual violence and strong stigmatization of people living with HIV and AIDS suggest that many cases of HIV are undocumented. Heterosexual transmission is the predominant means of infection.

From 2007 to 2011, PSI/PNG implemented a behavior change communication program with support from the Asian Development Bank (ADB), the Australian Government and the New Zealand Aid Programme (NZAID) to reduce the incidence of HIV in six of PNG’s rural economic enclaves for mining and agro-industrial companies. This program consisted of a men’s sexuality and sexual health workshop for male employees of the target enclaves, as well as community leaders and pastors from villages in the enclave footprints. With the goal of improving the quality of primary relationships through better sexual health and greater intimacy, the workshops were so well-received that PSI/PNG went on to develop a similar workshop for both men and women in 2010. The curriculum for this program continues to be used by both PSI and other international NGO’s working in PNG.

Condom Social Marketing

PSI/PNG’s nationwide social marketing of Seif Raida male and Stap Seif female condoms works to improve condom accessibility throughout the country. The program distributed more than 500,000 condoms in 2016, targeting migrant men in rural economic enclaves and key populations. 

Key Populations

Among certain populations, HIV prevalence has been found to be much higher. Results from the PNG Institute of Medical Research’s (IMR) Askim na Save study among people who exchange sex for money or goods^[1] and data from FHI360^[2] suggest that female sex workers (FSW) carry a much higher burden of HIV than other PNG citizens. The midterm review of PNG’s National HIV and AIDS Strategy emphasizes that HIV services and interventions for key populations such as FSW and men who have sex with men (MSM) are vital.

In 2014 to 2015, PSI developed and implemented the key populations behavior change communication strategy, Laip Blo Yu Em Dia Tumas, to promote the following four key behaviors among key populations:

• Consistent condom use.
• Quarterly HIV Counselling and Treatment.
• Monthly STI Checks (for services with testing).
• Adherence to antiretroviral therapy (ART), including filling prescriptions and taking consistently.

In 2015, with funding from the Australian Government, PSI developed the National Aids Councils Faith Based Organization Sub-strategy: Building an Enabling Environment for Key Populations Accessing a User-Friendly Service.

^[1] Kelly. A., Kapul. M., Man, W.Y.N., Nosi, S., Lote, N., Rawstrone, P., Halim, G., Ryan, C. & Worth, H. (2011) Askim na Save (Ask and understand): People who sell and/or exchange sex in Port Moresby. Key Quantitative findings. PNG Institute of Medical Research and University of New South Wales: Sydney, Australia.

^[2] USAID/FHI, (2011), Behaviour, Knowledge and Exposure to Interventions: Report From a Behavioural Surveillance Survey Port Moresby, Papua New Guinea

Gender Based Violence

Gender-based violence is a pervasive social problem in Papua New Guinea (PNG). An estimated 70% of women in PNG experience domestic violence in their lifetime (Brouwer, Harris and Tanaka, 1998). A 2013 study in Bougainville, PNG found that one in five women aged 18 to 49 reported that their first sexual experience was forced (Jewkes, Fulu and Sikweyiya, 2015). Economic and emotional abuse are also commonly reported by women (Jewkes, Fulu and Sikweyiya, 2015; Lewis, Maruia and Walker, 2008). This data is backed up by the experience of Doctors Without Borders/Médecins Sans Frontières (MSF), which has treated 27,993 survivors of family and sexual violence in the country since 2007 (MSF, 2016).

Among women who visited HIV counseling and testing services, 58% reported physical and emotional abuse in their intimate relationship and 44% reported sexual abuse. Consistent with global evidence on the links between violence against women and HIV (Garcia-Moreno and Watts, 2000), sexual abuse was found to be strongly associated with HIV positive status (Lewis, Maruia and Walker, 2008). Sexual violence undermines the ability to make free and safe choices regarding pregnancy, childbearing and contraception, and puts women at risk of HIV infection (Jenkins, 1993).

The gender inequalities that underpin gender-based violence also affect sexual and gender minorities (Myrttinen, Naujoks and El-Bushra, 2014). In PNG, men and women who report minority sexual and gender identities, such as transgender women, face disproportionate levels of violence, often from law enforcement, health care providers and family members (FHI 360, 2013).  

Safe Villages and Family Support Centre Assistance Program

With funding from the U.S. Bureau of Democracy, Human Rights and Labor (DRL) and the Australian Government, PSI began the Safe Villages and Family Support Assistance project in 2015.

The Family Support Centre Assistance program aims to support Port Moresby’s main center for survivors of gender-based violence through awareness and sensitization trainings for hospital staff and key duty bearers on the referral process for the Family Support Centre. Additionally, the program supports outreach to promote the Family Support Centre and builds capacity of community networks to conduct awareness-raising activities.

The Safe Villages project used a participatory action research methodology to develop and implement strategies for combatting gender-based violence in two communities near Port Moresby. With findings from DRL, PSI developed the formative research protocol Gender Inequality and Gender-based Violence: Community Perspectives, Community Voices – Using a Participatory Action Research Methodology.

SASA! Pilot

SASA! is a primary prevention model that has been proven to reduce intimate partner violence in target communities when compared with control communities. SASA! is currently being implemented in more than 52 countries globally. As part of this movement, PSI/PNG was invited in 2016 to participate in the South Pacific region’s first ever SASA! training conducted by Raising Voices, Uganda and UN Women and hosted by the Australian Agency for International Development (AusAID). PSI is now working to design the region’s first SASA! Pilot to be implemented in two communities: Sogeri, Central Province and Port Moresby, North Capital District. The regional design includes a full adaptation of the SASA! Toolkit for the PNG context as well as the design of the SASA! formative research protocol.

Tuberculosis

PNG has an estimated tuberculosis (TB) prevalence of 532 per 100,000 people, placing the country with the second highest TB burden in terms of incidence and mortality in the Asia Pacific region. 

PSI is sub-recipient to World Vision International (WVI) in implementing the Stop TB Strategy in Papua New Guinea partly funded by The Global Fund. The aims of this initiative include:

• Reducing TB prevalence and death rates by half of 1990 levels by 2020.
• Ensuring quality-assured drugs for TB and HIV are accessible to patients at all times.
• Improving quality of TB laboratory services with an emphasis on primary health care.

PSI supports the implementation of TB care and prevention in six priority basic management units (BMUs): the disease control unit of provincial health, local level government (LLG), community leaders, church leaders, women groups and a network of treatment supporters. These BMUs are located in four provinces and linked through a network of PSI TB liaison officers who work closely with the staff in order to:

1. Improve the quality of TB care and prevention implementation in the six underperforming BMUs.
2. Strengthen the Programmatic Management of Drug Resistant TB (PMDT) network, led by the central PMDT team.
3. Strengthen TB/HIV collaborative activities at the BMU level.
4. Ensure that quality of laboratory services performed meets accepted standards at the BMUs.
5. Sustain capacity to generate national data and reports.

Donors

• The Global Fund to Fight AIDS, Tuberculosis and Malaria
• The Australian Government
• ExxonMobil
• US Embassy to Papua New Guinea

Partners

• Various departments of the Government of Papua New Guinea
• National Department of Health
• National AIDS Council Secretariat
• National Family Sexual Violence Action Committee
• NCD Family Sexual Violence Action Committee
• NCD Family Sexual Violence Secretariat
• Pacific Women Shaping Pacific Development
• World Vision
• Save the Children
• Burnett Institute
• UN Women, Papua New Guinea and Fiji
• Raising Voices, Uganda
• Port Moresby General Hospital
• Family Support Center, Port Moresby
• Asian Development Bank
• The Government of the Commonwealth of Australia
• ExxonMobil
• Rotarians Against Malaria of Port Moresby
• PNG Institute of Medical Research
• Médecins Sans Frontières/Doctors Without Borders (MSF)
• University of Papua New Guinea 

Community sector partners: Child Fund, Ginigoada Bisnis Development Foundation, Equal Playing Field, NCD Women’s Council, PNG Sports Foundation – High Performance Centre, FHI360, Anglicare, Morobe Community Development Association, Moresby South Off-season Netball Association, Ward 9 Vendors Association, Matada Association, Urban Rural Development Foundation, Humanity Foundation for Moresby South, Morata Rugby Association, Tosin Kamut Youth Group, Yoga for Life, Walk for Life, Warrier Culture.

Private sector partners: ExxonMobil, Coral Seas Hotels, Oil Search Ltd, Ramu Agri-Industry Ltd, City Pharmacy