A maternal and child health program outcome evaluation study: examining the effect of a targeted village birth attendant program in Papua New Guinea
Creators: name: Kep, Julie Kamblijambi
Publisher: name: RMIT University
Year: 2024
Subjects: classificationCode: 420303
subject: Family care
classificationCode: 420499
subject: Midwifery not elsewhere classified
classificationCode: 451614
subject: Pacific Peoples public health and wellbeing

description: The World Health Organization’s (WHO’s) (2011) ‘right to health’ mandates that a safe birth is the right of every woman, regardless of context. As a low-income country, Papua New Guinea (PNG) has the highest rate of maternal mortality in the Asia Pacific region—reported in 2008 to be 733 deaths per 100,000 live births (WHO, 2010).<br><br>The aim was to conduct a modified retrospective program evaluation of a PNG university’s Bachelor of Clinical Maternal and Child Health (BCMCH) curriculum. Specifically, this study examined how knowledge and clinical skills were transferred sequentially from the BCMCH nursing students to village birth attendants (VBAs) and village child health workers (VCHWs), and then to rural women.<br><br>The sequential four-phase descriptive exploratory design used a retrospective approach. The first phase consisted of a formal curriculum mapping exercise of the previous University A[1] BCMCH curriculum for 2005 to 2009. The second and third phases undertook purposive sampling of BCMCH graduates from the same programs, which was matched with purposive samples of VBAs directly trained by the graduates. The fourth phase recruited snowballed samples of rural postnatal women, who had been delivered or attended to by the same VBAs .<br><br>Data collection occurred in two purposively sampled PNG areas. During Phase 2, of 16 face-to-face interviews were conducted with BCMCH graduates. During Phase 3, focus group discussions were held with VBAs. During Phase 4, face-to-face interviews were conducted with postnatal women. Documentary analysis was employing for Phase 1, and thematic analysis for Phases 2, 3 and 4.. Rigour was established by audio taping, content validity, member checking and triangulation.<br><br>The findings from Phases 2, 3 and 4 indicated concurrent agreement, in which University A’s BCMCH graduates felt that they were able to provide more valued care when educationally prepared to understand the sociocultural environment of the villages in which their clients lived, and could more clearly articulate their clinical practice. This curriculum knowledge was transferred to women through the targeted training of VBAs. However, highlighted was a paucity of educational and clinical resources.<br><br>The VBAs felt that their training enabled them to identify high-risk factors in women and ‘too sick’ signs in children. This acquired knowledge enabled timely hospital referrals during pregnancy and childbirth. The community health education component was seen to result in positive public health outcomes for rural families and communities.<br><br>The rural postnatal women stated that they had received new knowledge from the BCMCH-trained VBAs regarding preparing for delivery, which improved their past practices of delivering a baby unassisted. They also gained new knowledge on human immunodeficiency virus (HIV) infections, and family planning.<br><br>Based on its findings, this research recommends developing a new PNG postgraduate maternal and child health curriculum, with a substantial component focusing on VBA education, and community health practice. This research also recommends ensuring sustained learning resources are provided for both tertiary educational and clinical facilities. A critical component of the new curriculum should be using evidence-based public health interventions and practicum village placements.