McCully NZAID policy does little for women dying in PNG

Troubling news – as a good international citizen and friend to the Pacific what can and should New Zealand do to encourage the PNG government to address maternal deaths in childbirth and make good on their commitments to their citizens and their international human rights obligations? 
Posted by Phil Twyford on September 21st, 2009

Women in Papua New Guinea  are dying in childbirth at 23 times the New Zealand rate. That is 1500 women dying preventable deaths every year, and 30% of them are teenagers.

It is one of the most shocking indicators of a country in crisis.  The maternal death rate  in PNG, one of our closest neighbours, is on a par with Afghanistan. And there is no sign of improvement.

PNG has its share of problems: poverty, HIV/AIDS epidemic, corruption, and appalling governance. It’s the last on that list that is the big driver. The failure of the state to provide basic health services to its citizens is what has caused the skyrocketing rates of women dying in childbirth.

PNG health workers at a parliamentary hearing today on maternal health in the Pacific testified the key factors behind the figures are the collapse of rural health services, and now a dire shortage of trained midwives.

Foreign Minister Murray McCully likes to rail against aid to Pacific nations’ public sectors but the failure of the PNG public service to train midwives over the last decade has directly caused the preventable deaths of thousands of women in childbirth and heaven knows how many children.  Submitters at today’s hearing told how the PNG government decided in 2001 to shift all midwife training into universities but failed to put a curriculum in place. Since then no midwives have been registered.

Helping Pacific governments deliver services effectively, and be accountable to their citizens is exactly what our aid programme should be doing.

It is not rocket science. In the neighbouring Solomon Islands, maternal deaths went through the roof after political instability in the late 1990s saw a break down in health services. Since then the Solomon Islands public health system has cut maternal deaths by two-thirds mainly by focusing on training and deploying midwives and healthworkers.

Samoa is the success story of the Pacific in this area. It has achieved some of the lowest maternal death rates in the region, and this is widely attributed to a reformed public sector health service working alongside traditional birth attendants, good workforce planning and investment in training.

The same pattern is found further afield. The international stand outs in this area are Sri Lanka, Thailand and Malaysia who all recorded massive improvements in maternal death rates by investing in midwife training. Sri Lanka in particular made midwife services free to those who could  not afford to pay, expanded access in under-served rural areas, increased training of midwives, and raised awareness of women’s right to skilled birth attendants.

New Zealand’s taxpayer-funded development agency NZAID is doing the right thing in PNG. It supports the national department of health, and a midwife training programme run by the World Health Organisation, as well as a number of groups delivering health services at community level.

But here’s the rub. The new direction of the NZ aid programme driven by Foreign Minister Murray McCully flies in the face of this evidence from crisis-ridden PNG.  It  is hard to fathom the Minister’s desire to shift the balance of funding from Melanesia which is home to appalling social indicators and acute poverty on a massive scale, to Polynesia which already enjoys one of the highest rates of aid per capita in the world and relatively good social indicators.

But most of all the new mandate to focus on private sector economic development and free trade will do nothing to reduce the rate of mothers dying in childbirth.  Or kids missing a primary education. Or people without access to clean water.

The Minister needs to get over his ideological hostility to the public sector and recognise that improving governance and helping people hold their governments accountable is the immediate challenge if the Pacific is to tackle its appalling social indicators, like the rate at which mothers are dying in childbirth in Papua New Guinea.

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