REPORT ON THE PRELIMINARY PHASE OF THE RESEARCH AND DEVELOPMENT PROJECT IN PRIMARY HEALTH CARE
IN NEW IRELAND PROVINCE, PAPUA NEW GUINEA FEBRUARY 1980 - MAY 1981
PROGRESS REPORT
JointlY prepared by the Provincial Health Division New Ireland, Papua New Guinea and World Health Organization
Manila, Philippines Noveuber 1981
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TABLE OF CONTENTS
ACINOWLIDGDiEN'I'S .... ,. .................................................................... '" .. . . . .
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PROJECT STAFF 1. INTRODUCTION 1.1 1.2 1.3 1.4 1.5
.........................................................................................
1 1
Purpose and objectives of the project ...•.....••.•••• Project strategy ••.•...•••.....••...•........•.••.... Phasing of the project ......••....•...•......••.•.... Project staff ....................................... .
2 3 3 3 4
1.6 1.7 2.
Financial input ......•............•..........•..•..•• WHO/UNICEF collaboration ..•.............••.•.......•• VIP visitors and observers ............................... .................... . '
4 5
ACTIVITIES 2.1
.. .................................................................. ,. ........................ .
Initial preparatory stage
.••...........•....•...•••.•
5 5
2.1.1 Within the Provincial Government ..•••.••.••••• 2.1. 2 Wi. th in the COIDIDtDli ty .................................................. .. 2.1. 3 Drafting and submission of the project proposal. 2.2 Preliminary phase. February 1980 - May 1981 2.2.1 2.2.2 2.2.3 2.2.4 2.2.5 2.2.6 3. Social preparation of the community .•••..••••• Technical preparation of the health staff ..••• Village Development Committees •.•••.••••...••• Community diagnosis process •..•..•••••••••••.• Organization of a model villaae PHC programme and its field trial .......................... . Development of a village health information sys tern .............................................. ,. .............................. ..
5 5
6 6 6 6 7
7 7
OUTCOMES, FINDINGS AND OBSERVATIONS 3.1 Initial preparatory stage 3.1.1 3.1. 2 3.2 Within the Provincial Government •..•.••.•••... Within the community ......................... .
8 8 8 8 9 9
Preliminary phase 3.2.1 3.2.2 3.2.3 3.2.4
Expansion of project areas and VDCs •..•....... A model for staff development programme in primary health care .......•••..•......••.•.... Partnership between the health system and the cOUlll\m.i ty
10
........................................................................ ..
10 10 10
3.2.5 3.2.6 3.2.7
Community survey report •••....•••.••..••....•. PHC/VDC programme for 1981 - review and results. Implementation plan for development of the village health information system •.••••••.•..•• Kavieng Hospital statement of policy on primary health care .............................................................. .
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15
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TABLE OF CONTENTS (cont'd)
4.
FUTURE PLAN OF ACTIVITIES IN THE IMPLEMENTATION PHASE .... 4.1 Activities for the scoeond six months of 1981 4.1.1 4.1.2 4.2 4.3 Provincial Health Department/Project Office.. Villages in the project area ................
15 15
15 15 16 16 16
Workshops planned in later part of 1981 . . . . . • • • • • • . Research activities ................................
5.
CONCLUSION
ANNEXES ANNEX 1 ANNEX 2 ANNEX 3 ANNEX 4A ANNEX 4B ANNEX 4C ANNKK 5 ACTIVITIES FOR INITIAL PREPARATORY STAGE FOR THE DEVELOPMENT OF PHC PROJECT .•.................• WORKSHOP ACTIVITIES FOR TECHNICAL PREPARATION 1980-81 . • .•• . . . . . . . . . . . . . . . . . • . . . . . . • . . . . . .• . . A COMMUNITY SURVEY ON RURAL VILLAGES OF NEW IRELAND PROVINCE. PAPUA NEW GUINEA VILLAGE DEVELOPMENT ASPECT OF PHC PROGRAMME, PANACHAl S/MAD INA, 1981 . . . . • . • . . . . • . . . . . . . . . . . . PROGRAMME FOR PHC PROJECT IN PANACHAIS AREA, 1980-81 (HEALTH SERVICE ASPECT) ..............•• PROGRAMME FOR PHC PROJECT IN MADlNA AREA, 1980-81 (HEALTH SERVICE ASPECT) ...•....•....•.. KAVIENG GENERAL HOSPITAL - STATEMENT OF POLICY WITH REGARD TO PRIMARY HEALTH CARE IN NEW IRELAND PROVINCE, 1980 .. . .. . .. . . .. .. . .. .. . . • .. .. .. .. .. 19/20 21 25/26 105 109 113
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ACKNOWLEDGEMENTS
The project staff of the New Ireland Primary Health Care Development Programme are deeply indebted to the Health Department of the National Government. Mr R. See to, the Premier of New Ireland Provincial Government and the World Health Organization/UNICEF for their continuous support· and guidance, which made the successful completion of the preliminary phase possible. Last but not least, their most sincere thanks are due to the people of the villages in the project area, who have participated as partners of the health system in the implementation of primary health care activities with the determination to improve their villages and make them better places to live in.
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PROJECT STAFF I. Provincial Government Health System 1. 2. 'I.
Dr Levi Sialis, Project Director/Assistant Secretary for Health Mr Ishmael Penias, PRC Project Officer, Village Development Aspect Mr James Johang, PHC Research Aspect/Provincial Health Educator Ms Dinah Vesikula, PHC Training Aspect/Provincial Community Health Nursing Supervisor Ms Ursula Pula, Assistant PHC Research and Training/Provincial Family Planning Officer Mr Baski Kamis, Aid Post Order1y, Panachais Area Mr Andrew Lapan, Aid Post Orderly, Madina Area
4. 5. 6. 7. II.
Village Development Committees (VDC) 1. VDC in West Coast (Panachais Area) Mr Manau Kamis, Chairman, Ward 5 (WOC) Mr Lesley Pumaranai, Vice Chairman, Ward 5 (WOC) Mr Markus Ges, Chairman, Panachais Mr Simion Wanariu, Chairman, Panameko Mr Moses, Chairman, Pangeifua Mr Lesley Ba10, Chairman, Lafu Mr Josua Marantangis, Chairman, Usi1 Mr Manau Kamis, Chairman, Namasalang _______________ , Chairman, Belifu 1 & 2 Mr Hubert Piskaut, Chairman, Ward 4 (WOC) Mr Hosea Kavuk, Vice Chairman, Ward 4 (WOC) Mr Ludwik, Chairman, Lamusmus No.1 Mr Steven Unangui, Chairman, Lamusmus No.2 Mr Ti1ivuksion, Chairman, Lavo1ai Mr Daniel Bakap, Chairman, Panamafei 2. VDC in Eas t Coas t (Madina Area) Mr K.T. Sanaela, Chairman, Area Development Cornodttee (ADC) Mr A. Sirinda, Vice Chairman, Area Development Comodttee (ADC) Mr Ape1is Mazakmat, Chairman, Ward 13 (WOC) Mr Lokotop, Chairman, Panamana Mr Apelis Mazakmat, Chairman, Munawai Mr Vau1es, Chairman, Laraibina Mr Saku C:abriel, Chairman, Lugagon Mr Bolai, Chairman, I'anangai
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Mr Michael Homarang, Chairman, Ward 14 (WOC) Mr S. Tamela, Chairman, Madina Mr James Kutmat, Chairman, Luapul Mr Mohokang, Chai rl\k'm, Tofabi Mr L. Gamala, Chairman, Fissoa Mr Malesles, Chairman, Bura Mr Demas Kavavu, Chairman, Ward 15 (WOC) Mr Bumai, Chairman, Kafkaf Mr Dafut, Chairman, Kama Mr J. Maza, Chairman, Fatmilak Mr Boas Mais, Chairman, Bol Mr T. Padinga, Chairman, Lamalawa III. Advisers 1. 2. 3. 4. 5. Dr Mario Felszer, WHO Programme Coordinator for Papua New Guinea Dr W.p. Chang, Medical Officer, PNG/SPM/OOI Mr C. Nathan, Sanitarian, PNG/EHP/OOI Mr B. Fisher, Sanitary Engineer, PNG/EHP/OOI Dr K.S. Lee, Scientist, PHC, WHO Manila (Principal Adviser to the Project)
1.
INTRODUCTION
The Provincial Government of New Ireland has launched the Primary Health Care (PUC) Development Project in selected areas since early 1980 with WHO technical collaboration endorsed by the Central Government of Papua New Guinea. The ultimate purpose of the project is to providt essential information and experience for the new strategies for the development and implementation of a national health care system whi~ is undergoing a dynamic process of change in its efforts to achieve the goal of health for all by the year 2000. The duration of the project is a period of five years and 5 mooths from February 1980 to May 1985. Before the launching of the proj.c~, one year was spent as a preparatory period (see Annex 1 for activities during the initial preparatory stage). The prupose was to gain acceptance and support from various divisions of the Provincial Government and the community leaders concerned. The beginning of the actual project activity, the Preliminary Phase was 1II&rked by the first PlI: workshop for staff preparation in the Pl(: approach, which was held in February 1980 at Kavieng. Since the first workshop, a series of five workshops and training course have been conducted, two workshops semi-annually technically supported by WHO, (see Annez 2 for workshop activities, 1980-81). A WHO Consultant in PUC has provided technical advisory services since the inception of the project by visiting the Province semi-annually for a period of 2 to 3 weeks in each visit. The preliminary phase was completed at the end of May 1981, and took 16 months. This progress report covers the eleven months of the preparatory period and 16 months of the preliminary phase of the project development. InitiallY, the project commenced with seven villages in the west Coast (Panachais Area) and one village in the East Coast Oiadina Area} with a population of less than 1000. The project area is now being expan4ed to 12 villages in the West Coast and 20 villages in the East Coast with an approximate population of 5000. The project has just entered the implementation phase and is progressively expanding its coverage in both the population and content areas. The implementation phase is from June 1981 to May 1984, making a period of 3 years. The New Ire land Provincial Government has recently held a "Think Tank" meeting attended by Cabinet members and all Assistant Secretaries of the respective provincial divisions, including the Office of Policy and Planning. At this meeting, two additional seeding areas for primary health care development were recommended and it was decided to launch them in 1982. 1.1 Purpose and objectives of the project
The essential features of the PUC Development Project are the following: (1) The project activities coordinate with the socioeconomic and health-related services to help people deal with the many-sided problems of living that affect health.
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(2) It stresses the importance of health promotion and development and of increasing the capability of people to live a healthy and quality life. (3) It promotes individual and community responsibility and involvement in their own health care and protection.
(4) It is a part of the national health care system, which is an integral part of the national development plan, consisting of rneaHureH and acti vi ties undertaken at the level of first contnct in the cornrnunity for essential health care. More specifically, the project is to explore and identify/determine the following areas: (a) the multi-faceted problems of daily living of individuals and communities, and ways of solving these problems with special reference to health j (b) kinds of knowledge, attitudes and skills required by different categories of health workers in the promotive, preventive, curative, rehabi litative dimensions of health care and in the socioeconomic dimension; type of workers most suitable for different tiers of services and their training; (c)
(d)
ways and means of community involvement;
(e) ways and means of developing a linkage between people in the community and the health system, and their respective areas of responsibi li ty; (f) an information system to monitor the health needs of people and output of the PHC programme j (g) 1.2 financial mechanisms for the PIlC programme.
Project strategy
The main strategy adopted for the project 1S two-dimensional: it is research and development in health and health care. While the actual primary health care is being implemented in the villages, exploration and identification of various forces operating in health and health care will be simultaneously carried out. The research portion will generate essential information and hard data which will be fedback to the operation of primary health care to help design improved strategies for the continuous development of health and health care in a dynamic process of change. The development portion will progressively expand the content of primary health care as well as the population coverage as the capabilities of the health system and the communities develop. The significance of the project lies in its benefit to the community in relation to health development and to the national and provincial health system in the area of policy and strategy setting as the project is expected to generate valuable information required in policy setting and strategy designing to achieve the world-wide goal of health for all by the year 2000.
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1.3
Phasing of the project
In the original project proposal, the project phasing was planned as the following: 1.
Preliminary phase Implementation phase Evaluation and development phase
12 months 36 months : 12 months
2. 3.
Based on the project experience, the phasing has been revised as follows: 1. 2. 3. 4. 5. Initial preparatory stage Preliminary phase Implementation and development phase Evaluation and expansion phase Province-wide implementation 12 months, February 1979-January 1980 16 months, February 1980~May
1981
36 months, Jtme 19B1-May 1984 Jtme 1984-May 1985 : Jtme 1985 onward
The project will be completed by the end of May 1985. 1.4 Project staff
During the initial stage, one PEe Project Officer <health extension officer (HEO» was appointed on a full-time basis to assume responsibility for the project under the direction of the Project Director, the Assistant Secretary of the Provincial Ministry of Health (PlIO). The Provincial Commtmity Health Nursing Supervisor, Provincial Health Educator, Provincial Health Extension Officer. and the Provincial Family Planning Sister were the main manpower input to the project development in the preparation and conduct of PHC workshops and a commtmity survey. As of now, all categories of health workers in the provincial health system based in Kavieng and project areas are involved in the PEe development project in one way or another, as a part of their staff development in the PHC approach. The medical officer and HEOs from Namatanai Health Centre and nurses in other health and sub-centres in the province also participate in special project activities such as commtmity surveys or workshops. In addition to their respective areas of routine work, the Provincial Health Educator (PHE) and the Provincial Community Health Nursing Supervisor (PCHNS) have been given responsibility for research and organization of workshops to share the workload of the PHC Project Officer (PHC/PO), which has increased tremendously as the project has progressively expanded. The need for a research officer in the future is envisaaed. 1.5 Financial input
Approval for the funding of the project is still awaited since the submission of the request by the New Ireland Provincial Secretary to the
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- 4 Secretary for Health, Department of Public Health in Konedobu, dated 4 March 1980. 'lne first financial aid provided by the Provincial Premier amounted to 1000 kinas for the support of two workshops on the community diagnosis process and organization of the PHC programme in October 1980. 'inc Department of Public Health at the Central Government has also provided 1000 kinas to support two workshops on the sillTple research method and the PHC information system in May 1981. Ibe Director-General of WHO made a donation of an equivalent of US$lO 000 to the project area. The fund will be used to improve the village water supply system in the project area. Village Development Committees in the project areas have contributed in kind and labour for PHC activities including a village workshop and community survey. All other required expenses have been met by the Provincial Health Office within the limits of existing budgetary resources. 1.6 WHO/UNICEF collaboration
The World Health Organization provided 3 consultant weeks in 1979, 7 consultant weeks in 1980 and 3% consultant weeks in 1981, a total of l3~ consultant weeks with the PHC adviser from the Manila Office for the period of 28 months for technical collaboration in the development of PUC project. An equivalent of US$lO 000 was donated by the Director-General of WHO on his visit to ~he project area in West Coast area in September 1980. A team of three WHO staff members based in Port Moresby accompanied by the national counterparts visited the project area for 3-5 days in 1979 for the initial assessment of project feasibility. The team consisted of a medi"al officer. [I sanitarian. and a technical officer in the expanded programme on immunization. A team consisting of a WHO Sanitary Engineer. a Sanitarian. a Medical Officer and a national Sanitary Engineer counterpart. all based in Port Moresby. visted the project area to assess the ti!chnical feasibility of improving the village water supply system, funded by the Director-General's contribution, in February 1981. UNICEF provided a land cruiser to be used as a project car in early 1981. Four PHC films and PUC slides have been provided, on a loan basis. for the workshops when needed. Ten rolls· of color films were provided by WHO in 1980.
1. 7 VIP visi tors and observers The site in Panachais area was visited by Dr H. Mahler, Director-General of WHO, Dr H. Nakajima, Regional Director of the Western Pacific Region of WHO, Dr M. Felszer, WHO Programme Coordinator in Papua New Guinea, accompanied by Mr J. Jaminan, National Minister for Health, Dr A. 'l'aruti a, Se cretary for Health. and other national dignitaries, in September 1980.
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- 5 The National Coordinator for PHC in the National Department of Health, stationed in Port Moresby. and five other provincial health officials visited the project area in both sites and participated in the five~day training workshop on simple research methods and vital statistics. held in Kavieng in May 1981. In February 1981, a team of WHO officials accompanied by the national counterparts was also received by the project staff and the villages. The Uni versi ty of Papua New Guinea has used the project as its field practice area for students in social work since late 1980. 2. 2.1 Initial preparatory stage ACTIVITIES
2.1.1 Within the Provincial Government Initially, the Provincial Management Team (PMT) , which consists of all divisional heads of the Proyincial Government, was approached by the Project Director (PHO) and the PHe concept and approach were individually explained as far as possible. A PMT meeting was called. and hoste~ by the Project Director when a WHO team visited Kavieng in February 1979. The concepts and approach of PHC were explained and individual views in relation to the feasibility of PHC project were exchanged. The intersectoral nature of PHC development was discussed. At a later stage, PMT was to function as the PHC Coordinating Committee at the provincial level. Intrasectoral cooperation was sought within the Division of Provincial Health through staff meetings and individual contacts were possible to introduce the PHC concept and familiariaze the health staff into Pac project and its app~oach, ~y the Project Director. Constant follow-up action was taken whenever Iossible and whenever needed during the first year of the preparatory period to secure inter and intrasectoral cooperation and coordination through acceptance of the Pac approach. 2.1.2 Within the community A number of contacts were made with the community leaders, and formal and informal leaders to obtain acceptance and support for the PUC concept and project approach. A number of village meetings with leaders add health staff were held to measure the community interest and their potential for PHC project deve lopment. Through cons tant follow-up acti vi ties in this period, community interest was confirmed and motivation heightened. A decision was made to form a Village Development Coamdttee (VDC) g~ded by the project staff. 2.1.3 Draftina and submission of the project proposal TIle project proposal was finalized with the assistance of the WHO Consultant in Primary Health Care, and the Provincial Secretary submitted it to the Secretary for Health, Department of Public Health in the Central Government on 4 March 1980 for the attention of Dr B. TaUkuro, Assistant Secretary (Health Planning and Health), for an approval of the required funds for the 5 year project period. The funding has not yet been approved.
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Pre liminary phase, February 1980 - May 1981
TIle activities described in this section have focused on important areas rather than on events in chronological order. 2.2.1 Social preparation of the community In addition to individual contacts made by the project staff, members of VDCs in both project areas have been invited to participate in all the PIIC workshops (fi ve workshops so far) except for one technical training cOlJrse on vital statistics and research method. Thirteen members from 18 of the 20 newly organized VDCs participated in the recent workshop on the PHC information system, hosted by the Area Development Committee in the East coast in May 1981. TIle chairmen and members of VDCs in the initial project areas have been fairly well prepared socially in the PUC approach to implement the village development programmes, which have been (0 ,-mul atl'd ilt the workshop. VDC members have also been socially prepared to moni tor certain aspects of the vi 11 age health services performed by APlls and other health staff from the Health Centre and Provincial Health Office. Details of the workshop attended by the VDC members are attached in Annex 2. 2.2.2 Technical preparation of the health staff In addition to the field work from which health staff obtained learning experience in the PHC approach, the planned learning activities have included a series of six workshops since the inception of the Pre liminary Phase of the project. TIlese are, in ch ronological order, as follows: (1) (2) (3) (4) (5) (6) Orientation workshop on PHC approach and New Ireland PHC project proposnl Connnllni ty diagnosis te"hniques Community diaenosis process - data analysis and presentation Organization of PHC activities at various levels Simple community research method and vital statistics Information system at PHC level
TIle health staff together with VDC members and village volunteers carried out community surveys in both project areas in April/May 1980, Details of workshops as regard to the objectives and participants are attached in Annex 2 for further information. 2.2.3 Village Development Committees
TIle Village Development as a permanent mechanism for for primary health care. It implementing, and monitoring
Committee (VDC) has been organized to serve channeling village resources and efforts is the basic network unit for organizing, primary health care at village level. ,
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It serves as a linkage 'between village individuals and the peripheral health services and other services of the government system and nongovernmental organizations. It is the voice of the village people ~d partner of the health system in health development. It is a basic information post for village development where basic information such as births, deaths and other simple health and population statistics are collected, kept and channelled through to the health system when needed. The chairman and other officers of the VDC are elected by villagers themselves. The functions and roles of the VDC will be progressively refined as prilll&fY health care deve lops in its coverage and content areas. Organization of the VDC has begun since the latter part of the Preparatory Stage. It now controls various external inputs to the community frpm all sources including health. 2.2.4 Community 4!agnosis process In order to gain actual learning experience in a community diasnosis process and at the same time to assess the village situation i~ terpB of problems, needs and resources, a community surw.y was carried o~ in the initial project areas during the months of April and May 1980. 'The survey was planned, implemented, analysed, and graphedlcharted jointly by the health staff and VDC members and village volunteers. The findings have been used as a basis for the organization of an initial village PRC model programme. Field testing for the questionnaire was carried out prior to the main survey. The survey report is attached in Annex 3. 2.2.5 Organiz,tion of a model village PHC programme and its field trial The findings of the community survey in the initial project areas were used as the basis for the planning and organization of a village PMC prograDlllll. The pros,ramme will serve as a model for the newly exp8l'lded project areas. The programme was put on a field trial for a six-month period from Movember 1980 to April 1981. It ... reviewed duri~8 the May Workshop by the VDCs aId project staff (see the findings of the field trial under Seetion III). The model prog..... has been orsanized in the following format; 1.
Priority problem areas Objectives
S. 6.
Peraonnel or locus of responsibility Resources required and avai lab Ie Target dates Remarks
2. 3.
Target
7. 4.
Activities 8.
2.2.6 Development of a village health information system A five-day training workshop was conducted in May 1981 to familiarize health staff with a simple community research method for data collection and vital statistics. This wo~hop was followed by a five-day PHC workshop on the information system in PHC project a~eas. The latter was hosted by the VDCs in the East cout area eMadina}. ~oximately, 30 VDC members from 32 villages in two project areas which had recently been expanded. and 20 health staff from the provincial health system .. . 1
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attended. At the information workshop, the following areas of the village information system were discussed and it was decided to have them put on a three-month field trial before this becomes a permanent system applicable to all villages. 1 PHD 1 (PUC Project Office) WC/ADC -~ l. Birth registration at VDC -~ 2.
Death registration at VDC
-~
WC/ADC
-~
PHD
(PHC Project Office) -~ PHD (PMC Project Office)
J. 4.
Pregnancy reporting at VDC -~
Mcn clinic -~ HC
Family health information system Family -~
VDC
-~
WDC/ADC-~
PHD
(PHC Project Office)
The development of the village health information system is part of the research portion of the PHC project. The birth, death registration and pregnancy reporting are scheduled to start from July to September 1981 in all villages in the project areas while the family health sheet will be tried out in 7 selected villages for the same period. The findings will be discussed at the October Workshop for the finalization of the information sys tem. 3. 3.1 OUTC(MES, FINDINGS AND OBSERVATIONS
Initial preparatory stage
3.1.1 Within the Provincial Government The Provincial Management Team included a PMC Coordinating Committee as one of its functions at the provincial level. The PHC project staff were identified and assigned the responsibilities of the PMC development project in addition to routine work of their respective work areas. The Project Officer was appointed on a full-time basis. A PHC team was organized consisting of a project officer (lIEO) for VDC organization, 1\ community nursing supervisor for research and training, a POO/medical offict'r for overall direction of the project, APOR for peripheral PIC workers, and VDC chairman for the village development aspect. 3.1.2 Within the community A Village Development Committee in each of two initial project areas was organized to serve as a mechanism through which community participation and various government and non-government inputs in the villages are channeled for the overall development of the villages including primary health care. Various community organizations existing prior to the PUC 1
WOC denotes Ward Development Committee. ADC denotes Area Development Committee. See An Organizational Structure of VDC for PHC Programme on page 9. PHD denotes Public Health Department.
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project were absorbed into the VDC, which has now become the basic unit for I'HC implementation. 3.2 Preliminary phase
3.2.1 Expansion of project areas and VDCs As of May 1981, the initial project areas with approximately 1000
population with only two VDCs have now grown to cover approximately 5000 population in 32 villages with 26 VOCs in a total. The organizational structure of VDCs in the project areas is as follows: Organizational Structure of VOCs for the PHC Programme
PHC Coordinating Body
I East Coast Area D.C. West Coast Area D.C.
1"4
3 Ward D.C.s I
;_.[1 I n~
2 Ward D.C.s
._------
-
~
~
11
15 VOCs
=::r-
iIll
11 VOCs
1
.-
20 - 60 Families
20 - 45 Families
2997 Population
1831 Population
The inclusion of new areas into the PHC project and the organization of VOCs have been decisions taken by the villagers and their leaders. As the project progresses in quality and in quantity, the vicinity of the project areas appears to have been affected by multiplier effects on the outside of the project area which have been found to be increasingly operating as the project progresses.
r---, ~ ___ ~ L -__~I
Key:
To be organized Have been organized I COlPPlunication chcmnel
- 10 3.2.2 A model for staff development programme in primary health care A series of PHC workshops condllcted to prepare the health staff in the PHC approach to the project could serve as a guide for the development of a model curriculum for the staff development programme. The materials are reserved for th is purpose. 'l.7. 1 _l~artnership
between the health system and the community
A relationship of partnership has been established between the health system and the conullunity in the project areas. The partnership has gradually developed through continuous joint activities in every PHC development process, such as the community survey, workshops, VDC organization process, and PHC programme planning, implementation and review processes. 3.2.4 Community survey report As the survey was carried out jointly with the health staff and the VDC members, graphing and charting were also carried out as a joint activity. The three sets of flip charts for the survey findings were produced by the workshop group in October 1980 and a set is now available at each of two VDCs in the original project area and at the PHC project in Kavieng. Ibe set of charts in each area is now being used for teaching purposes as well as for a model for new areas. 3.2.5 PHC/VDC programme for 1981 - review and results (a) Village development programme
As shown in Annex 4A, Village Development Programme in both areas, the content area has been reviewed at the May workshop. The following are examples of the targets achieved: (1) Improvement of housing: 10 houses with iron-roofing are being built in Namasalang in Panachais area and 3 houses in Madina area. (2) Improvement of village water supply: The Provincial Sanitary Inspector has prepared an implementation plan for the village water supply project funded by the contribution made by the Director-General of WHO (US$lO 000). Upon the receipt of funds, the project will be completed in two-months with free manpower from the respective villages concerned. The recommendation of the WHO team for the technical aspect is being considered. -However, the use of the iron roof of the cooca drier as a catchment area for rain water recommended by the team will be changed to another clean catchment area. (3) Demonstration garden: completed. A fence for the garden has been
(4) Prevention of damage to farm products by pigs: As decided, all the adult pigs in three villages out of seven in Panachais area have been killed or sold. In Madina, 40 pigs have been
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killed so far. One family in Namasalang village and four families in Madina village have built pig pens. (5) Expansion of project area: The PRC project areas have been expanded to include 19 villages in East Coast (Madina area) and 5 villages in West Coast (Panachais area), whereas originally only 10 villages were targeted. The project areas now cover a total of 32 villages with a population of approximately 5000. There are now 27 village development committees in the project area. (b) Health service aspects of PRC programme (1) Vector control: As planned, the Panachais area now has a storage house for spray equipment and chemicals, and housing facilities for the village assistants to the spray team. The.e facilities have been built as part of the PBC programme as targeted. Madina area has not been followed up as noted by the VDC at the review session. (2) Activities of aid post orderlies: Planned activities of aid post orderlies in the project areas have been carried out fairly well. They now use a planned weekly work schedule. Activities iDelude 3 days of clinic services, 2 days of field visits in village, and emergency services during the weekends. Co~selling and health education now include various aspects of village life problems with special attention to health. This is a new developmant. (3) Inputs of various basic health services: Tnis is ilentified as the main problam area noted at the review session. Th. VDC meuiJers have pointed out that the health staff engaged i. basic health services have not followed the activity plan as scheduled. It was thought that the health staff did not have a clear idea about how to link their activity with the project activity using the PMC approach. The village people pointed out that t_e health staff failed to assume the responsibilities as they did not carry out follow-up activities in most cases. This seemed to raise two issues: one is the technical supervisory system for health staff and the other the possibility of social monitoring by the VDC. These issues need to be studied in order to strengthen the monitoring system for basic health service input in the village level. For the 1981 programme, it was decided to carry it out as programmed and have it evaluated at the end of 1981.
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3.2.0 Implementation plan for development of the villaee health information system (1)
Vital event report system - reporting channels
!WDC/ADC
7
!
H.C.
7
! PH.D 7
Bi rth
within 7 days after events
----7 Reg. book
Monthly,report _______ M~o~n~t_h_l~y~c~o~l~l~~ction ' [ompilation/ analysis
Death
"
____)~
Monthly)report ______M~o~n~t~h~l~y~C~o~l~l~~ction Reg. book compilation! analysis Mobile )linic _.-,} Man th ly renort , compi lation! Notebook analysis subm~onthly)collection
(3)
Prep,nancy
As soon as identified
____~)
Illness
Family Mont~ Health Sheet Oai ly Re cordi np.
. (1) '~ake Village Health Sheet"
Monthly coll,ction compi lation! analysis
(2) "Population
Statis tics"
- 13 -
(2)
Forms to be used (a) Date/ Birth Birth Registration Book Names/ Parents Place of Birth VDC/Vi llage: Date of Report Reported by Remarks
Reg. No.
Sex
(b)
Death Registration Book VDC/Village:
Reg. No.
Date/ Death
Name
Age
Sex
Place of Death
Cause of Death
Remarks
(c) Date/ Report (d) Reg. No.
Pregnancy Report VDC/V'll 1 age: Outcome of Preg.
Woman's Name
Age
Address
Gestation
Clinic
Remarks
I
Month1l Famill Health Sheet
or Morbiditl
Re~()rt
I
Panachais/Madina PRC Project, New Ireland Province Name of head of household: Name of Village: Month/Year: 1. Please check everyday for each person for one month. completed, please give it to your VDC Chairman. When this form is
Me_ar. 1
Falilly
I
Ilex A•• 1 2 3 4' S
;6
~
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 2 24 25 26 27 28
~
In ~1
.- t-- tI I
12 I,
I" 5
,
,
,
IA 17 18 I~
, ;
! :
10 LItL ~cqr4.d
- 14 Check the appropriate box with the following symbols as appropriate: - when a person was sick and could not work: X and seen by APO:([) - when a person was sick but was still working as usual:
!:1 and
seen by APO:
@
- when It person was sick, stayed hOIT~ and was seen by a tradi tiona1 healer or has taken traditional medicine: ~ - when a person was sick but still working or walking about, using tradi tional medicine:@) - leave blank if the person was not sick - when a person went to Lamekot H.S.: + - when a person went to Provincial Hospital: ++ (e) Vi llage Heal th Sheet
Month/Year
Healthy
Remarks
(f)
Village Population Statistics Sheet
Sex/Age Male Female Total
o-
1 yr
1 yr - 5 yrs
5 yrs-15 yrs
15 yrs +
Tot a 1
All the forms are to be prepared and provided by the Project Office. (3) Time-table for field trial
Act i vi ty /Month Preparation of forms Field preparation Field trial Spot check Data analysis
June 1981
July
August
Septemer
October
-
-
-
- -
-
- 15 -
(4)
Sample villages for field trial (a) 4 villages in East Cpast and 3 villages in West Coast are being selected for a three-month trial of the family heatlh information system. (b) Birth, death and pregnancy registration will be field-tested in all villages (32) of 28 VDCs in the project area for a three-month period. (c) Trial of the village health information sheet and population statistics sheet will be promoted among those VDCs where a trial of the family health sheet is being conducted.
(5) Compilation and analysis of data will be ready by the second week of OctoDer for the review and evaluation of the village health information system. If feasible, the system will be adopted in the entire project areas.
3.2.7 Kavi.uS Hospi tala tlts_nt of policy on primary health care
After the first workshop in February 1980, the Provincial Ho89ital staff formulated PBC policy for hospital staff activities. The statement is attached in Annex 5 and is self-explanatory. 4. FUroRE PLAN
OF ACTIVITIES IN THE IMPLEMENTATION PHASE
4.1
Activities for the second six months of 1981
4.1.1 Provincial Health Department/Project Office
(a) ~)
Follow-up on PHC project areas Preparation of various village health information forms Field preparation for trials of various village health information systems Spot checks and monitoring of field trials and data collection, compilation/analysis of field data Preparation and organization of two village workshops and two PHC information system workshops in October/November 1981 Review of project progress Preparation of 1982 programme budget and activities
(c) (d) (e) (f)
(g)
4.1.2 Villages in the project area
(1)
Families (a) Daily recording of family health sheet from July through September 1981 in seven sample villages.
. .. I
- 16 (b) Birth, death and pregnancy report to the VDC 1n all villages of the proiect area. (2) VDCs (a) (b) ;IS
Imp lemen tation of vi llag£' deve lopment progrannne as planned Monitoring of input of basic health services into village progrannned in the health development aspects of PHC progranune
(c) Collaboration in implementation of field trial of vital event reporting system with the project staff (d) Collaboration in preparation of and participation in the forthcoming workshops on PHC information system in October and November 1981 (e) Preparation and hosting of two village PHC workshops in October 1981, one in Fat Milak, another in Lamusmus 4.2 ~orkshops
planned in later part of 1981
(1)
PHC village workshops for newly organized VDCs - a three-day village workshop on PHC approach on Lamusmus VDCs, 21 - 23 October 1981 - a three-day village workshop on PHC approach in Fat fnlak, 14 - 16 October 1981
(2)
PHC project workshops on village information system - a five-day workshop on analysis of family health sheet - a five-day workshop on follow-up of village information system
4.3
Research activities (1) Field preparation and trial of a family health sheet in seven selected villages for three-month period
(2) Field trial of vital registration system and its analysis in all villages (3) Writing up of report on field trials 5. CONCLU SION
The experience gained during the preliminary phase of the project has been most valuable to all concerned, the health system and the community. It has given the opportunity to build up a high degree of the confidence required in implementation of a new approach such as primary health care. Unlike other existing health care approaches, every step and activity carried out in the course of the PHC project has been a learning process
II
I
. . .1
- 17/18 for the health staff and the community concerned. The entire PUC development period will therefore consist of education and socialization processes for all concerned. Technical competence and social conviction which have begun to develop in this process will hopefully influence the political and bureaucratic processes for resource allocation with a view to their more rational use in reaching the goal of health for all. Some impact of the project is evidenced by the provincial decision to launch l'HC development in two other districts in 1982 as seed projects, recollllllended by the "'Ulink Tank" group meeting held in Harch 1981. The most important development is the change in the people's attitudes and behaviours. The people have begun to display some confidence in their own abilities to take counteraction when negative forces operate and threaten the health and quality of life of the villagers. The expansion of the PMC development areas from 8 original villages to 32 villges with 28 organized VDCs is a visible act of will by both parties, the health workers and the village people concerned. Another impact of the project can be observed in the change in the direction of the five-year Provincial Health Plan, 1981-1985, which is based on PHC policy. The Provincial Minister for Health, Mr Maul Karau, expressed his willingness to make budgetary provision for PMC development, in his opening address at the workshop. In his speech addressed to the Workshop Group in October 1981, the National Health Minister, Mr Martin Tovadek announced that he would send a check of 1000 kinas to be used for the project activities upon his return to Port Moresby. Ibe National Coordinating Committee for primary health care at Port Moresby has now become functional and the National Coordinator for primary health care, Mr Paul Duega, has been appointed. Observers from the Provincial Health Departments of Rabaul, Manus, Port Moresby, Wewak and Daru attended the recent workshop on research methods and vital statistics. As recommended at the National Workshop on primary health care held in Popondetta in March 1980, the New Ireland PHC project is being utilized as the teaching-learning ground for the PHC approach. There are some examples of the impact that the PHC project has had on the process of deve 10pment. In oonclusion, the road to the PHC development farm is now being charted and the seeds of PHC that have been planted have begun to grow and produce some fruit. However, they require care and attention until their roots get deeper into the ground and are able to develop into mature trees that can produce as many healthy fruit as possible, so that they can be shared throughout the province and country. Until that time, these PMC trees need fertilizer and protection from political storms, technical malnutrition, logistics and managerial deficiency, and administrative neglect. The project has now entered the maturation phase (Implementation Phase) and will hopefully bear many fruits of knowledge and skills that can be transplanted elsewhere.
_;.\~EX
1
ACTIVITIES FOR INITIAL PREPARATORY STAGE FOR THE DEVELOP~NT OF PHC PROJECT rEBRCARY 1979 - DEC~~ER 1979 NEW IRELAND PROVINCIAL HEALTH OFFICE FUNCTION/PURPOSE 1.
ACTION To familiarize with PHC concepts and to form a Coordinating Committee for PHC develo~ment Proiect
PERSONS INVOLVED
I
I
OIJTCOME Gained PHC concept and support for PHC programme
DATES February 1979
Establish relationship with P.M.T.* and all Extension workers
I ,
P.M.T. Director Politicians Extension Officers Church P.M.T. Director Provincial member Councillors Extension Officers (Church & Govt) PHD, Project staff, All extension officers Churches & Govt. all extension officers, community leaders, Provincial members Director, P.M.T. All extension officers
2. -To explore possible ways of approach to gain acceptance and support for PHC in the province 3.
One day workshop f01 P.M.T., Director, I Provincial members, i Councillors and all extension workers Field visits to: Panachais & Madina Areas One week leadership course for leaders in the areas concerned Meeting with Directo r and P.M,T.
Draft proposal of progran~e for Coordinating Committee
I
I
I
To obtain the approval and support from community leaders To confirm the acceptance
Acceptance and support of village leaders Forming of V.P.C. Cooperation and coordination, team work
t-'
'.0 N
---0 I
4.
& support from community leaders
5.
Follow-up of the above action
Progressive development of cooperation from other sectors
January 1980
*p .M. T. :
Provincial Management Team
I I
ANNEX 2
WORKSHOP ACTIVITIES FOR TECHNICAL PREPARATION, 1980-1981
ACTIVITIES Workshop 1:
OBJECTIVES
METHODS
PARTICIPANTS
DATES/VENUE
OUTCOME
1. To familiarize the PHC Presentation concept and multi/inter of working sectoral approach in papers To orient various health health development staff of New Ireland Group work Provincial Government 2. To identify roles and Field visit in PHC approach used in possible impacts of to Project PHC Development Project community efforts in area PHC Development Project health development
Staff preparation for
-3 medical officers
26-29 Feb 1980
and 4 senior nursing staff from Prov. Provincial Hospital Assembly Hall
Statement of policy with regard to PHC in New lreland by Kavieng Provincial Hosp. A Hospital task force to help Panachais project Statement on roles of various
of people 3. To identify roles of different levels of health care delivery system in New Ireland Province in relation
Films on
PHe
-All staff members of in Kavieng Provincial Health Office -Senior staff of Lema kot Health Centre -2 APOs from Panachai and Madina -2 Chairmans from v.Dlc. in Panachais & Madin -1 Politician 30 Participants
levels of health care system Hospital, Health Centre. Aid Posts and Community
Established a mechanism for intra-unit coordination with-
in provinCial health sector Role clarification of various health staff in PHC N ~
to PHC. 4. To identify and define PHC Team and interrelationships of its members
Workshop 2: Community Diagnosis Technique Purpose - To prepare & assist Community members &
1. To identify its own community problems
V.D.C. leaders in the initial process of a community programme
2. To define priority problems/needs & explore possible ways of problem solving 3. To identify and mobilize resources
- 16 members of variou 3-7 March • 80 health staff Panachais 14 V.D.C. members an· field testing village volunteer of survey from Panachais form on 2 & Madina areas villages in orientation sessions
- Finalization of questionnaire form for community survey Implementation and completion of a survey on two
villages in Panachais Established a permanent mechanism for community
Panachais
30 Participants
Group discussions
planning
to support the proposed Actions 'to
participation'
solve community
problems
WORKSHOP ACTIVITIES FOR TECHNICAL PREPARATION. 1980-1981 Annex 2
ACTIVITIES
OBJECTIVES
METHODS
PARTICIPAlffS
I , DATES/VENUE
I I
I
OUTCOME
I
Workshop 2:(cont'd) Purpose - To help health staff develop basic skills in the community diagnosis and problem solving - To experiment partnership between health staff and the community people in the process Workshop 3: Community Diagnosis Process - Data analysis and presentation Purpose - To complete the community diagnosis process by analysing and presenting data through actual learning experience -Group work on 9 VDC -.iJers/ - To describe & present graphs and village volunteers various data in gracharts fro. Panacbais phic/chart/pictorial and Madina forms -Group discuss11 Health staff ions - To explain overall pictures of the -Classroom Total 20 community problems instruction and situation in graphs & charts - To determine priority problems based on findings of the survey 27-31 Oct'80 At the Provincial Assembly Ball. Kavieng
,- Developed a partnership between health system -and the community - Experienced in a community survey
I
N N
- Developed skills in graphs charts and other pictorial forms using the survey data - Learned to interprete data presented in pictorial forms
1Developed a sense of accom i plishment by completing 3 sets of the charts and graphs for community survey
- Priority problems are identified
WORKSHOP ACTIVITIES FOR TECHNICAL PREPARATION, 1980-1981
Annex 2
ACTIVITIES Workshop 4: Organization of PHC Activities To organize PHC project activities in accordance
OBJECTIVES - To set the problems which should be tackled in order of priority - To plan the target and activities required for each problem area
METHODS Plenary sessions Group Work
PARTICIPANTS 5 VDC members from Madina 7 VDC members from Panachais
DATES/VENUE
OUTCOIIE - Determined priority problems and needs - Developed Village Health Component of PHC programme and Implemen-
3-7 Nov, 1980 Provincial Assembly Ha11, Kavieng
Presentation
with priority problems determined on the basis of the survey findings
- To plan and allocate resources for each problem a~ea
(1981 Annual Plan)
of imp lementation plan or finished product
6 Provincial Health Stsff 2 Hospital Staff 2 Lemakot Health Centre Staff 3-4 Staff from policy & planning 4 Politicians 1-2 Others
tation plan (timetable) for 1981 activities in Panachais and Madina - Developed Village Development Component of
- To identify and allocate responsibi-
lities to health staff and V.D.C. for each problem area
PHC programme and a timetable for 1981 activities in Panachai. and Madina
- To formulate an implementation plan of
N·
PHC Activities for 1981 Workshop 5: Simple research method and vital statistics for Health Staff, New Ireland Province
Total 42
'"
-To describe basic steps and procedures
for simple community heal th research
Clasroom ins truction Practice on Computation Discussions
30 participants 23 staff members from P.H. Office Hospital, Lemako Health Centre 1 Provincial membe 6 Observers:
4-8 May 1981 Provincial Assembly Hall, Kavieng
- Recognition of urgent need for development
of information system - Computation skills in vital statistics - Better informed of procedures for simple community survey
To familisrize simple resea~h
method and use of
vital statistics in PHC
-To interprete & use essent ial vital statistics -To compute essential
vital statistics including morbidity, mortality & natality
Field trip t Panachais an Madina
Annex 2
WORKSHOP ACTIVITIES FOR TECHNICAL PREPARATION, 1980-1981 I
ACTIVITIES l."orksho2 5: (cont'd)
OBJECTIVES - To analyse basic data using rate and ratio, etc.
MEHODS
PARTICIPANTS 6 Obervers: National Health Department in HQ. (National Coordinator for PHC)
DATES/VENUE : I i, I
OUTCOME
i , I
I
5 Provincial Heal h Departments ineluding East New Britain, We wak, Central Pr vince, Port Mor sby. & Sepik Pro
, , I
.
. I I
i , ,
.p..
N
I
Worksh02 6: Information system in PHC project areas To review Village PRC programme in project areas and to develop simple and effective information system at village level. To review and adjust village PHC development programme for the second six months of 1981 'Plenary discuss ion Group work 18-22 May '81 frOlJl Mad ina , Pa achais and Lamus~ Madina Co=unity Hall mus areas 20 Health staff 30 V.D.C. membe rs
I
Practical To develop simple reporting task system for vital events from village level to Field obserAPO/VDC vat ion To device family and viI lag 2Presentation health information sheets finished product To device simple village socio-economic information sheet 0
I . "
I I
.
.
.
I.
.
- 25/26 -
,
ANNEX 3
DRAFT
20 April 1981
A COMMUNITY SURVEY ON RURAL VILLAGES OF
NEW IRELAND PROVINCE, PAPUA NEW GUINEA
by
Research and Development Project in Primary Health Care New Ireland Provincial Health Office Papua New Guinea with
WHO collaboration
- 27 -
Annex 3 TABLE OF CONTENTS
1.
INTRODUCTION METJl)DOLOGY Survey area and population Duration of survey Procedures FINDINGS
1
2. 2.1
2 2 2
2.2 2,3 ·3.
.
.
2 2 2
3.1
Demographic characteristics Physical environment Socio-economic conditions Health conditions of the community Cultural factors related to health and illness Morbidity and health practice Summary and conclusion
3.2
3
3.3 3.4 3.5 3.6
4 6
... 10
3. 7 Table. Table 1 2
- Total number of population surveyed in Panachais and Madina project areas by age groups, 1980 . . . • • - Population in Panachais Project Area I by villages, 1980
12 13
3 - Number of families and average n~er of persons per family and number of children under IS years of age by vi llage . . • • • • . • • . • 4 5 6 - Number of population surveyed by villages and age group in Panachais Project Area, 1980 - Population surveyed in Madina Village by sex and age group. 1980 • • • • . . . . . . • . • . • • . - Number of families and average number of persons per family, number of children under IS years of age, Madina Vi llage, 1980 . . • . • • . . . •
14 IS
16
17 18 19
7 - Housing materials of villagers by type of material Panachais and Madina, 1980 • • • • • . • • • 8 - Type of water supply in Panachais and Madina project areas, 1~ 80 . . . . . . '. . . . . . • .'. . . . . . . .
- 28 Annex 3 Table 9 Number of responses on toilet facilities in Panachais and Madina project areas, 1980 . . • " •....• 20 21 22
10 - Number of responses on means of livelihood Panachais and Madina areas, 1980 • • II
- Number of responses on type of crops produced Panachais and Madina area~,
1980
·· .
12
-
Number of fami lies with different type of livestocks in Panachais and Madina areas, 1980
····
23 24 25 26 27 28
13- Number of responses on cOllUllOn1y used means of transport Panachais and Madina areas, 1980
······· · · · ·
14 15
-
Number of responses on ownership of radio Panachais and Madina areas, 1980 Number of responses on COll'unon 1y used stores Panachais and Madina areas, 1980
·· ·
· ·
16 - Number of responses on use of gardening Panachais and Madina areas, 1980 •• 17 - Number of families with church-going by frequency Panachais and Madina areas, 1980 . • • • • • • • •
18 - Health conditions by village in Panachais Project Area, 1980 • • • • • . • . . . . . • . • .29 19 - Health conditions by age groups - Panachais Project Area, 1980 • • • • • • • • • • . • • . . 20 - Number of health problems in villages by conditions in Panachais Project Areas, 1980 • • . • •.... 21 - Number of health problems in different age groups by conditions, Panachais Project Area, 1980 • • • • . . 22 - Health conditions of people by age groups Madina, 1980 • • • • • • • • • 23 - Number of different categories of health problems by age groups, Madina, 1980 . • . . • • • • • • 24 - Number of responses on knowledge/beliefs in causes of illness, Panachais and Madina areas, 1980 • . • • 25 26 30 31 32 33 34 35 36
-
Number of responses on beliefs in taboo foods for pregnant women, Panachais and Madina areas, 1980 ·
· ··· ····
Number of responses on experience of illness in family during a week, Panachais and Madina, 1980 ·
37 38
27 - Number of responses on experience of Malaria in family Panachais and Madins areas. 1980 · · . · ·
..··
··
- 29 -
Annex 3 Page 39 40
[,able 28 - Number of responses on infant's age of first ~upplementRry foods, Panachais and Madina, 1980 29 - Number of responses on first contact person at the time of illness, Panachais and Madina, 1980 • • • • Figures Figure 1 Populations of registered resident and surveyed in Panachais Project Area by villages, 1980 • • • .
41 42 43 44 45
2 - Housing materials of villagers in Panachais and Madina Project Areas. 1980 survey. • • • • . • • • . . • • . 3 - Type of water supplies in Panachais and Madina Project Areas surveyed in 1980 ••••••.•.•••••• 4 - Sources of livelihood in Panachais and Madina Project Areas, 1980 survey . • .••••••.•••• 5 - Percentage of families with different livestocks owned in Panachais and Madina Project Areas, 1980 6 - Percentage of responses on commonly used means of transport by villagers in Panachais and Madina Areas. 1980 . . . . . . . . . . . . . . . . . .
46
7 - Percentage of responses on most commonly used stores. Panachais and Madina Areas, 1980 • • . • • • •• 8 - Percentage of responses on use of gardening in Panachais and Madina Project Areas, 1980 • • • • . 9 - Percentage of responses on frequency of church-going Panachais and Madina Areas. 1980 • • • • • . • • 10 - Health conditions of popUlation surveyed by village in Panachais Area, 1980 • • • . • • • . . • • • • • 11 - Health conditions of different age groups, Panachais Project Area, 1980 Community Survey • • • . • . • • • 12 - Percentage of health problems by conditions. Panachais Project Area. 1980 • • • . • • • • • • • . • • •• 13 - Percentage of health problems in different age groups by conditions, Panachais Project Area. 1980 •••• 14 - Percentage of people with and without health problems Madina Project Area. 1980 • • • • . . • • . •• 15 - Percentage health problems in all ages by conditions, Madina Project Area. 1980 • • . • 16 -Percentage of health problems in age group of over 15 years old by conditions. Madina Project Area. 1980
47 48 49 50 51 52 53 54 55 S6
- 30 -
Annex 3 Figure 17 - Percentage of health problems in age group of 1 to 5 years by condi tions, Madina Project Area, 1980 • 57
18 - Percentage of health problems in age group of over 5 years to 15 years by conditions, Madina Project Area, 1980 58 19 - Percentage of responses on knowledge/beliefs in causes of illness, Panachais and Madina Areas, 1980 . . . . . 20 - Percentage of responses on beliefs in taboo foods for . pregnant worrent, Panachais and Madina Project Areas, 1980 . • . . • . . • 21 - Percentage of responses on experience of illness family during past week, Panachais and Madina Project Area, 1980 . • • • • . • • • • . • 22 - Percentage of responses on infant's age of first supplerrentary foods introduced, Panachais and Madina, 1980 . • • • . • • • . • • 23 - Percentage of responses on first contact person at the time of illness, Panachais and Madina, 1980 ~n
59
60
61
62 63
- 31 1.
INTRODUCTION
Annex 3 page 1
A baseline survey was carried out in the Panachais and Madina PUC project area to diagnose the community in relation to health and living environment. This survey was a part of the preliminary phase of the research and development (R&D) project in primary health care. Since the R&D project focuses on the processes of development rather than the result, the survey is designed to be used as a learning experience for both health staff and the people of the community concerned. All the processes of community diagnosis - planning, data collection, and data analysis of the survey were carried out by the Provincial Health Department and the community concerned as a joint venture. The community participation was channeled through the Village Development Committee (VDC), which had been established as a mechanism for community participation. As implied, the community diagnosis process was the beginning of testing ground for the health staff and the community to determine whether both parties could develop abilities to work together toward the common goal of health and development.
The experience has so far proved to be positive in that regard. The experience has suggested that appropriate role models for both parties in primary health care could be developed if this joint relationship in the process of PRC development and implementarion continues. The following describes the findings of the survey in which the health staff and the community concerned were involved in the entire process. Purpose and objectives of the survey As mentioned in the introduction, the purpose of the survey was twofold: first, to provide baseline data for the PRC development project and second, to develop the abilities of the community and health staff in community work, in general, and in the community diagnosis process, in particular. Specific objectives of the survey were to identify/determine the following areas: (1) (2) (3) (4) (5) demographic characteristics; physical environment; socioeconomic condition; health conditions of the community; cultural factors related to health •
. Feedback of information into organization of PHC project The findings of the survey have already been fed back to the project· for the organization of PHCimplementation, which took place in October 1~80 through as-day PHC organization workshop in Kavieng.
. .. /
- 32 Annex - - -3 page 2
2.
METHODOLOGY
2.1
Survey area and population
The survey area consisted of seven villages in the Panachais area wi th a population of 902 and one vi llage in Madina area wi th 236 people. Panachais area is located in the West Coast while Madina in the Eas t Coas t of the mainland area of New Ireland Province. 'lhese are the initial areas of the PHC development project. 2.2 Duration of survey The survey was carried out during the months of April through May 1980. 2.3 Procedures
The survey questionnaire form was developed and field tested during the month of February 1981. The form which contained 30 items was then fina1i7.ed (see attached questionnaire). Interviewers The 14 community volunteers from the project areas and health personnel from the Provincial Health Department of New Ireland participated as surveyers after having received a preliminary orientation on the community survey. The content of the survey required two broad areas: one requiring professional health/medical skills for physical examinationj the other required interviewing skills only. 'lbe 14 community volunteers participated as interviewers and used structured interview schedules while health personnel examined the health condition of individuals in the villages. Heads of households or adult persons were interviewed by the community participants while all members of the fami lies present were examined by the health staff. Vata analysis
The data collected were compiled and analysed by the same participants at a two-week workshop in October 1980. Ibe process of data analysis was used as a leming process for health staff and community volunteers. 3. 3.1 FINDINGS
Demographic characteristics
As table 1 shows, of 788 population surveyed in 7 villages of Panachais and one village in Madina PHC project areas, 46.6% were under 15 years of age, which implies a heavily dependent population. The population under one year of age was found to be 3.1%, while the proportion of children over one to five years of age was 8.5%. Since there was no way of finding out the exact age of the villagers, the hroad classification
•. • 1
- 33 Annex 3 pape 3 of age group with approximate ages was used in this survey. The age distribution in both project areas showed a similar trend although Panachais area included seven villages whereas Madina area included only one vi llaee (Tab leO. The breakdown of age groups by villages in Panachais area is shown in Table 4, which is very close to the general picture. In Panachais area, the distribution of the resident population in each of seven villages were found to be consistent with the registered population ~igure 1). The population covered by the survey was 87.4% of the resident population (1980 census) and the population by village (Table 2) revealed a similar pattern of distribution to that of the resident population except that a slightly higher representation (6%) in Belifu Village and a slightly lower one (2.9%) in Pangaefua village are noted. Average sex ratio of the population surveyed in the Panachais area was found to be approximately 106, ranging from 76 in Usil Village to 122 in Belifu Village. The total number of families surveyed in Panachais area was 165 ranging from 15 in Usil to 41 in Belifu. The average size of the family was 4.8 of which children under 15 years of age occupied 2.2. Usil Village was revealed to have the largest family size, which was 6.0 while Pangaefua Village showed the smallest, 3.5. The average number of children in these villages was 1.4 in Pangaefua and 3.6 in Usil (see Table 3). In Madina Project area, the sex ratio was 107. However, the sex ratio in different age groups did not show a consistent pattern. The number is too small to draw any conclusion. (Table 5). The 1980 census data were not available for Madina area at the time of this study. In Madina, 50 families were included in this study. Average number of persons per family was 4.7 and the number of children under 15 years per family was 2 (Table 6). 3.2 Physical environment
3.2.1 Housing materials As shown in Table 7 and Figure 2, of 156 households surveyed, 10.3% of the housing was observed to be built of bricks and iron roofing, which is known as "complete housing" while 50.6% of households were living in houses built of bush materials. Houses built of bush materials with iron roofing were 39.1%.
In Panachais area, the majority of the housing (61.3%) was found to be built of bush materials, while in Madina area "iron roofing" was the predominant feature of housing (54%). "Bush materials" and ''brick/iron'' types accounted for 28% and 18% respectively. The proportion of "iron roofing" in Panachais was 32.1% while only 6.6% belonged to the ''bricks/iron'' category. Iron-roofing in this part of the country adds significant meaning to living as it provides a catchment area for rain water. The kind of housing material used in general is related to the wealth of the family. In this context, the economic conditions of Madina area
... /
- 34 Annex 3 page 4 appears to better than Panachais area although the number of household surveyed in Madina was too small to be conclusive. 3.2.2 Type of water supply lhe majority (58.4%) of families surveyed ~n both areas enjoy water from either private tanks or common mnks while one third of the families usc river and spring water (Table 8 and Figure 3). When the situation is reviewed by area, a predominant proportion (92%) of Madina families use private (78%) and common tanks (14%) while less than 50% of Panachais families uses water tanks of either the private or common type. Nearly one half of Panachais families were found to be dependent on river (26.4%) or spring (22.6%) water for their water supplies. 'llie type of water supply is consistent with the proportion of iron-roofing as the roofing serves as catchment areas for rain water. Private tanks in this survey refers mostly to 44 gallon drums. 3.2.3 Basic sanitary facilities Of 156 households, slightly more than half (58.3%) had some type of toilet facilities while the rest claimed that they have no such facilities (Table 9). When the findings were reviewed by area, a predominant proportion of Madina was revealed to have such toilet facilities (82%) while in Panachais ~ and no toilet groups were equally divided. No other basic facilities such as proper drainage or washing facilities were found in either area. 3.3 Socioeconomic conditions
3.3.1 Main means of livelihood As Tab Ie 10 and Fi gure 4 show, the main means of livelihood in both an'as is farming, of which cocoa, coconuts, and buai are the main crops (sl.!e Tab Ie 11). The samlle r pe rcentage of traders found in Madina compared with I'anachllis area is assumed to be duC' to the location of the village, wh i ch is cl ose to the town, K.1vieng, the commencial centre of the Province. l'he latter is readily accessible to people in this area, whereas the villages ill th<.' Pnnacllais area nre strung out at a distance from the town. 3.3.2 Livestock It was found that a predominant number of families (87.2%) in the surveyed area raised livestock such as chicken and/or pigs. More specifically, the proportion of families with both chicken and pigs was 50% while those of families with pigs only, and· chicken only were 21.2% and 16.0% respectively. (see Table 12 and Figure 5). In Madina, 90% of families have either pigs or chicken or both while Panachais has a slighly lower percentage of families (86%) owning these livestock. In detail, the proportion of families with "pigS/chicken", "pigs only" and "chicken only", in the Madina area are 66%,12%, and 12% respectively, whereas the Panachais area revealed 42.5%, 25.5% and 17.9% for. "pigs/chicken"
... /
- 35 Annex 3 Paee 5 "pigs only" and "chicken only" respectively. This seems to suggest that Madina area may be economically in a slightly better position. 3. ]. '3 Means of transporc.! It was not a surprise to find that the majority of villagers use another's car as a means of transport to and from town and for visits to relatives (see Table 13 and Figure 6). Only an average of 10.9% of families in both areas use either their own transport or group hired transport. The 14.1% of families have no access to any type of transport except for hitch hikes. In Madina area, 20% of families were found to use their own car or group-hired car when transporting cash crops to the town for sale while Panachais area has only 6.6% of families doing the same. The availability of transport appeared to be linked to the number of village stores, which in turn is related to the distance to town. 3.3.4 Means of communication Individually owned radio is the only means of communication (one way) available from the branch of the national broadcasting system in Kavieng town to villagers. About one half of families surveyed owned transistor radios. However, when this is broken down by area, Madina people were far more accessible to radio communication (70%) than Panachais people (41.5%) (see Table 14). 3.3.5 Location of commonly used stores Slightly more than half the families were found to utilize village stores only, the remainder using either the town stores or both. As Table 15 and Figure 7 reveal, the majority of people in Panachais area utilize village stores (64.2%) while the Madina area shows a preference for both types of stores (64%). More families (10.4%) in Panachais area than Madina (6%) are found to use the town stores exclusively. The utilization pattern of stores is assumed to be influenced by such factors as geographic accessibility and available means of transport. 3.3.6 Use of gardening Generally, all~e families in the province do some form of gardening for either family use or for sale or both. More than half the families (58.3%) were found to have gardening for both sale and home consumption. '!be proportion of families doing gardening exclusively for home consumption was less (39.1%) than that of families with combine~. purposes. The difference in proportion in use of gardening in both areas was very small (see Table 16 and Figure 8). 3.3.7 Church-going The majori ty of the population (77.8%) was found to be regular church-goers (see Table 17 and Figure 9). Only 2.7% of families in both areas responded that they never go to church. The common religion in these areas is Christianity,
... /
Annex 3 page 6
- 36 !
. By frequency of church-gol-ng, th e " once a wee k" group was f oun d to be the largest one (61.4%) followed by the "sometimes" group and then the "bi-weekly" group. On the whole, Panachais area appeared to have more regular church-goers (68.9%) than Madina area (46%).
3.3.8 Summary
Although each area surveyed has an access to coastal areas (East and West Coast), the farming of such cash crops as cocoa and coconuts is the main means of livelihood. Fishing was not observed to be included as a means of livelihood. Pigs and chicken are common livestock and the majority of families keeps these livestock. The means of transport is limited in both areas. A nominal proportion of families use either a private or group hired car when they are in the cash crop business. Radios owned by a limited number of individuals are the only means of communication (one way) from K~vieng Town to the villaees. Village stores are more readi ly uti 1i zed for <lai ly goods than the town stores. Mos t families in both areas were found to use some forms of gardening for sale and home consumption. The majority of families surveyed were regular church-goers and "once-a-week" attendance was the conunonly observed frequency of church-going. Except for the "church-going" item, Madina area was revealed to be in a more favourable position in all the socioeconomic related items, which suggests the better socioeconomic status of that village. 3.4 Health conditions of the community
3.4.1 PANACHAIS AREA 3.4.1. I General Of 788 people surveyed, 291 persons or 35.7% were found to have one or more complaints or health problems while 22.3% of people fell into the "unknown" category. The proportion of persons without a complaint was only 42%. Since the proportion of the "unknown" category was 22.3%, the real percentage of the healthy population may have been different from 42% (Table 20 and Figure 10). 3.4.1.2 Health status by village When the percentag~ of people with health problems were reviewed by villages, Laefu Village was found to have the largest proportion, 62.9%, while Pangaefua was only 22.8%. However, the latter had a greater proportion (19.3%) of the "unknown" category while the former had only 2.8% of the same category (see Table 18 and Figure 10). 3.4.1.3 Health status by age group When people with health problems we~e studied by age groups, the under I year group was found to have the largest proportion (75%) in the healthy category while the 1-5 years group had the largest proportion of unhealthy children (48.44). The 1-5 group appeared to have more unhealthy children than healthy ones (43.8%) although 7.8% of children fell into the
•. • 1
- 37 Annex 3 page 7 "unknown" category (Tab Ie 19 and Figure 11). The 5-15 years age group showed the largest proportion of the unknown category and this phenomenom was assumed to be the result of school attendance at the time of survey. The adult group also revealed a high proportion of non-participants in the survey as many adults may have been working in the field at the time of the survey. 3.4.1.4 Specific health problems As the result of physical examinations, three major health problems have been observed. These are problems related to dental health (27%), skin conditions (25.1%), and eyes (15.8%). A similar pattern of distribution was observed in different villages although the order of distribution was changed slightly as "ears" and "enlarged glands" replaced "eyes" in some villages (Table 20 and Figure 12). A total of 430 health problems were detected among 612 persons, an average of 0.7 problem per person examined. The number of health villages ranged from 1.38 nwnber of health problems be 0.55 ranging from 0.32 problems per person with complaints in different to 1.73 with an average of 1.53. The average per person in the study area was found to to 0.99 (Table 18).
3.4.1.5 Major medical problems by age groups When major medical problems were studied by different age groups, it became clear that certain conditions were more prevalent in one age group than others (Table 21 and Figure 13). For example, dental health problems. predominated in the adult group while skin conditions predominated among children in the 1-15 years age group. Although the number in the "under 1 year" group was too small to show any significant findings. skin infections seemed to be a major problem. Wi th regard to "enlarged glands" and "cough/ear infection". school children were observed to be most affected while the adult group was least affected. In short, skin conditions. eye infections. enlarged glands were observed to be the major source of health problems among children under 15 years while such problems as dental, eye and skin conditions predominated among the adult population. Skin and dental conditions were the most important health problems among children and adult population respectively. 3.4.2 MADINA AREA 3.4.2.1 General health condition
In the Madina area. the proportion of people with complaints was slightly higher than that of people without. The "unknown" group was only 6.4% of the population studies (Table 22 and Figure 14).
. .. /
- 38 -
Annex 3 Dage 8 Although the nuui>er was too small to draw any conclusion, the "under I year" group was healthiest 000%) while the "I year - 5 years" and "5 Year!' - IS years" groups we re respecti ve ly observed to be evenly divided among those with and without complaints. The adult group showed more people with health problems than without. (Table 22). 3.4.2.2 Specific health problems The average number of complaints per person in the study area was 0.63 while that of persons with health problems was 1.26. As observed in the Panachais area, Madina area also revealed skin (40%), dental (24.3%) and eye (15.7%) conditions to be the three major health problems (Table 23 and Figure IS). When the age is controlled . " and " dental " b l' . ( see T able ) 12 the order of " sk~n pro ems ~s reverse d ~n the adult group (Figure 16) whereas the "I - 5 years" (Figure 17), and "over 5 - 15 years" (Figure 18) groups suffered chiefly from skin problems. All infants in Madina were observed to be free of health proble_ at the time of this survey (Table 22). The major problem in the "1 -5 years" group was "enlarged spleen" while that of the school-aged group was dental problems (11.9%). 3.4.3 SUMMARY In general, the proportion of persons with and without health problems was found to be about the same when the unknown group was excluded. Three major areas of health problems related to skin, dental and eyes. skin skin have draw Among the adult population, dental problems were more important than problems while among the child population this was reversed. Although problems were predominant in the infant group, this group seemed to the least medical problems. However, the number was too small to any conclusion.
The adult population appeared to suffer more from dental, skin and eye problems in order of importance while the problems of skin, eye and enlarged spleen were more prevalent among children under IS years of age. 3.5 Cultural factors related to health and illness
3.5.1 Perception of causes of illness Less than one half (46.8%) of families seemed to perceive illness as the result of invasion of germs while the remainder perceived it as the result of "evil spirit", "God's punishment" or "combination of these" (see Table 24 and Figure 19). Only less than 10% belonged to the "do not know" category. Panachais area was observed to have much higher proportion who responded to illness as caused by '''Evil spirit" (24.5%) and "God's punishment" (8.5%) than Madina area (10% and 2% respectively). It is suspected that the perception of people of causes of illness may be related to the proportion of church-goers, although a cross-analysis of data was not done. Panachais area revealed a much higher proportion of regular church-goers.
. .. /
- 39 -
Annex 3 T>age 9 3.5.2 Taboo foods for pregnant women A large majority (86%) of people were observed to have beliefs in taboo foods for pregnant women. The common taboo foods reported were such big fishes as shark and malisa. Some believed pork to be taboo (see Table 25 and Figure 20). Only 10.2% were found to have no taboo foods. Papaya and certain vegetables are also believed to be taboo for pregnant women. Panachais area revealed a much higher proportion of families (90.6%) who believe in taboo foods than Madina area (76%). This finding is consistent with the trend revealed in other relevant items. This finding has significant implications for the nutrition of pregnant women as the taboo foods observed are the main source of protein. 3.6 Morbidity and health practice
3.6.1 Morbidity A majority of families (58.3%) were found to have experienced no single illness during the period of one week retroactively from the time of the survey (see Table 26 and Figure 21). However, one third of the families claimed that they had experienced some kind of illnesses during the period and 6.4% have had 3 or more sick persons in their families. Madina area was found to have less experience of sick persons than its counterpart area. 3.6.2 Experience of malaria About one half of the families claimed that some of the family members had experienced malaria during recent years (see Table 27). Since it was impossible to obtain accurate information relating to the time, the question was posed as one of general experience with malaria without a given time period. 3.6.3 Supplementary foods for infants As Table 28 and Figure 22 reveal, the majority of infants (62.8%) are introduced to the first supplementary foods before the age of 6 months. The implication of this finding for health education would be the greater content and vaiety presented by supplementary foods. Although there is ..• a greater proportion of the "unknown" category (22%) in Madina area, the . finding in the "3 to 6 months" category is consistent with the counterpart area (50%). 3.6.4 First contact person when sick Table 29 and Figure 23 show, the aid post (60%) was found to be the most popular facility used by sick persons followed by the village chief and family elders. Churches (10.2%) and traditional heal~rs (9%) were revealed to be used by a similar proportion of people. The health centre was least used by villagers (2.5%). The low utilization rate of health centre may be due to geographical accessibility although this was not true in Madina as the village is relatively close to Lamekot Health Centre. The utilization pattern of facilities in both project areas showed Ii striking similarity. The findings suggest that the village chief and traditional As
... /
- 40 Annex 3 page 10 healers are a potential manpower which could be tapped and utilized after appropriate training. Aid posts need to be strengthened to acconnnodate the health demands of villagers. 3.7
Sunnnary and conclusion
Through this joint venture in the processes of a connnunity diagnosis, which included the planning and conducting of the survey, and analysing the data collected, an attempt was made to develop a partnership relationship between the health system and the community. The experience in each process of activity was a mutually supportive one which is ass1.Ulled to have contributed to the development of feelings of partnership in health development. This partnership could be strengthened through a continuous joint venture in the process of PHC development. As regards the findings, the following baseline data were obtained: (1) Demographic characteristics show a large dependent population (46.6% under 15 years of age). Exact age distributions were impossible to determine owing to the inadequate registration system and memory gaps of interviewee. (2) More than one third (35.7%) of villagers was found to have one or more health problems or complaints at the time of the survey. Three major health problems detected were dental health, skin infections and eye problems. The average number of health problems per person was 0.55. The dental. problem was more prevalent among the adult population while the skin problem was observed more readily among children. No differences Ln the pattern of health problelllS were found in both project areas. (3) The majority of the housing consisted of bush materials (50.6%). However, approximately 40% of the families surveyed in both areas had iron-roofing, which provided a catchment area for rain water. (4) The majority (58.4%) of families in both areas used either private tanks of 44 gal. drums or common tanks for their water supplies while one-third of the families used river and spring water. The number of families with private tanks was related to the number of families with iron-roofing as expected. (5) Basic sanitary facilities such as a toilet were available to only 50% of families. (6) Madina area appeared to be in better position than Panachais area in relation to physical facilities Ln general. (7) The main means of livelihood was farming of cash crops such as cocoa and coconuts. A slightly higher proportion of village trade shops was observed in the Panachais area. Fishing was not observed to be included in the means of livelihood. (8) A large majority (87.2%) was found to own livestock such as chicken or pigs or both.
... /
- 41/42 -
Annex 3 pap,e 11
(9) The majority of villagers relied on another's car while only 10.9% had access to an individually owned or group-hired car for their
transport.
No public transport was available.
(]O) Only one third of fannlies who owned transistor radio had access to one-way radio communication from Kavieng town, the local radio system. (11) Village stores were better utilized in Panachais area while Madina appeared to use town stores more frequently as the latter is close to the town. (12) Gardening was found to be an essential part of the livelihood for home consumption and for sale. (13) The majority of people were once-a-week regular Christian ch urch-goers. (14) In all aspects of socioeconomic conditions, except for church-going, the Madina area was revealed to be a better position than its counterpart area. (15) Less than one half of the families (46.8%) appeared to perceive an illness as be result of an invasion of germs into the body while more than one third seemed to believe in evil spirits or God's punishment. (16) A large majority believed in taboo foods for pregnant woment. These taboo foods included large fish like shark and malisa. Pork, papaya, and certain vegetables were also considered to be taboo. (17) About one half of the families claimed to have experienced malaria among family members in recent years. (18) The majority of infants (62.8%) were introduced to the first supplementary foods at the age of 6 months or earlier. (19) Aid post orderlies were the first contact persons among a majority of villagers (60%) when they are ill. Only 2.5% of families claimed that they went to the health centre when they were sick. Village chiefs and traditional healers seemed to playa significant role in health care of the villagers as they were used by almost one third of the fannlies. As mentioned in the Introduction, it should be cautioned that the findings of the two project areas are not intended to serve as a general comparison as Madina represents .only one village while the Panachais area includes seven such villages.
Table 1 - Total number of population surveyed in Panachais and Madina project areas by age groups, 1980
~I ! Area I
Under 1 year No. 28 4 %
1 year to 5 years No. %
Over 5 years to 15 years No. 279 79 %
Over 15 years and older No. 417 130 %
TOTAL
, No. 788 236 %
i , I , Panachais* Madina"'* I
I I I I
I 3.6 1.7 ,
64 23
8.1 9.8
35.4 33.5 .
52.9 55.0 I I
(77.0) i 100.0 , (23.0) , 100.0 (100.0) : 100.0 ! -----_.-
I , !
~
.-J
i TOTAL 32 3.1
! , I
87
8.5
358
35.0
I
547
53.4
1024
_
-----------'
*Panachais project area includes 6 villages, namely Belifu (209), Laefu (105), Namasalang (102), Panamesho (168), Pangaefua (114) and Usil (90). **Madina area includes only one village.
III ::) :1Q ::) CI> CI>
" > ...... X
'v
w
Table 2
- Population in Panachais Project Area I by villages. 1980
? " ro ill QQ
III
,
.... w
~
I Population I
!-~ges , .
.IiI -'---. :! I
"
Belifu 1 and 2 No. %
I ,
Laefu %
I I , i
Namasalang No. % 14.7 14.2
Panamecho No.
! I
f
w
Pangaefua % 18;7 17.4 No.
Usil %
TOTAL
: No. 151
% i No.
No.
% 100.0 100.0 I i
! Total population , I
' 218 200
21. 2
I 14.7; 152
I
207 179
20.2 19.8
j
192 157
108
10.5 10.9
I: , I I
1028 902
: Resident population ;
i
20.2' 140 I
!
15.5
128
! i
98
i
11
J 1 ;
1
,
Population surveyed TOTAL
II
, : Male
Ii
'I "
, , 209 115 J"T
! ,
26.5' 105 28.4' I ""-Y.J
13.3 , 12.1 ... , . . V
102 55
13.0 j
I
168 85 83 31
21.3 21.0 21.7
I 114 62
14.5 15.3 13.6
90
11.4 I 9.611 13.31 I I
" I d
788 405 383 165
100.0 100.0 100.0
i i
~
~
I
!i
49 JV
I ,
I ,
13.6i 12.3'
39
.. , 19
I
52 32
i ,
51 15
I ,
No. of families -
I
41
!
1
I
23 -
I
i
I
i
i
I
87.4% (788 people) of total resident population (census of 1980) was included in the survey.
Table 3 - Number of families and average number of persons per family and number of children under 15 years of age by village
Belifu land 2
Laefu
I Namasalang I
panamecho--l-pangefua-l-I
T Usil
I 1 I
I
TOTAl --
I
INo. of families
I
I
41
23
19
31
32
15
165
IAverage
number of persons per family
!
Average number of chi Idren under 15 years
I I
I 1
5.1
4.5
5.4
5.4
3.5
6.0
4.8 .;:\J1
2.3
2.5
2.5
2.3
1.4
3.6
2.2
I I
~
C'I~ (l) (l)
III ~
»
.;:-w
.....
><
"I;> ()Q
III
Table 4
- Number of population surveyed by villages and age group in Panachais Project Area, 1980
,...
'1l
= = ft) )<
\J1w
Under 1 year No. Belifu 1 and 2 Laefu Namasalang Panamecho Pangaefua Usil %
Over 1 year to under 5 years No. %
Over 5 years to 15 years No. %
Over 15 years (Adults) No. 113 %
TOTAL No. %
8 2
3.8 1.9 4.9 3.6 3.5 3.3 I
19 9 9 10 6 11
9.1 8.6 8.8 6.0 5.3 12.3
69 46 33 56 35 40
33.0 43.8 32.4 33.3 30.7 44.4
54.1 45.7 53.9 57.1 60.5 40.0
209 105 102 168 114 90
100.0 100.0 100.0 100.0 100.0 1 .p.. 0-.
48 55 96 69 36
5 6 4 3
100.OJ
I
--------------~--------------r_------------_r--------------~--------------,i
TOTAL
28
3.6
64
R.l
i
279
35.4
417
52.9
788
100.0
Table 5 - P<lpu1ation surveyed in Madina Village by sex and age group, 1980
I
~-
. Age group Under 1 year --------=..:.:.
Sex
-.
Over 1 year to 5 years No. 11 %
Over 5 years to 15 years No. 39 40 %
Over 15 years and older No. 69 61 %
TOTAL
No. Male Female 3 1
%
No. 122 114
%
75.0 25.0
48.0 52.0
49.0 51.0
53.0 47.0
51. 7 48.3
12
.....
.eo-
TOTAL
4
100.0
23
100.0
79
100.0
130
100.0
236
100.0
'" 111 'lII f!)
::::s ::s f!) >:
~'w
.., > III :;j ()Q:;j
Table 6 - Number of families and average number of persons per family, number of children under 15 years of age, Madina Village, 1980
.... w
"' "' >< .....
Number of families Average No. of persons per family Number of children under 15 years of age
50 families
4.7 (female 2.3. male 2.4) 2 children per family (same sex ratio 1:1) 106 (50% of total population)
ex> "' "
Table 7 - Housing materials of villagers by type of material Panachais* and Madina*, 1980
Area
~ Panachais Madina
Bush materials No. 65 14 79 J %
Iron roofing No. 34 27 61 %
I
Brickliron No. 7 9 16 %
TOTAL No. 106 50 156 %
I
I
I
61.3 28.0 50.6
32.1 54.0 39.1
6.6 18.0 10.3
I I
f
100.0 100.0 100.0 .I>-
I , I
'.0
L
TOTAL
j
*Panachais area includes 5 villages namely, Belifu (41), Namasa1ang (19), Panamecho (31), and Usil (15), while Madina area includes only one village in the survey (data).
()Q
II> ;:I ::l
o :> til til 1><
,...
(Xl '...>
'"0
C!Q (1)
ll>
::s ::s (1)
:l>-
Table 8 - Type of water supply in Panachais and Madina project areas, 1980
...... ><
"'w
iArea I
~ upp1y Panachais Madina
River water No. %
Spring No. \ \ %
Common tank No. 11
Private tank* %
Combination of 2 or more types No. 9
TOTAL
I I I , , I
No. 34 39 73 -
%
%
No.
%
I I
! 28 1 29 26.4 2.0 18.6 L_
24 3 27
22.6 6.0 17.3 -
10.4 14.0 11.6 --~ ------~
I
I , I I
32.1 78.0 46.8 - - - --
8.5 0 5.7 -
106 50 156 -
100.0
I , I J1
7 I
0 9 -- -
I
i 100.0 , ,
C
TOTAL
I I
18
I -----
I
100.0 --------
-----
-
-
I
*Private tank includes 44 gallon drums.
Table 9
- Number of responses on toilet facilities in Panachais and Madina project areas, 1980
----~I Area
j ! I
Have toilet No. 50 41 %
No toilet No. %
TOTAL
J % I
I I
I I I ,
No. 106 50 156 -
Panachais Madina TOTAL
I , i , :
47.2 82.0 58.3
56 9
42.8 18.0 41.7 -
100.0 100.0
I I I
i I I
91
I
I
65
L i
I
.... VI
100.0
I ,
,
---
i I
" > : 5 ~ ~
N~
Ow
~
~ (1)
ll> N
> ::s ::s (1) ><
Table 10 - Number of responses on means of livelihood Panachais and Madina areas, 1980
...... 1...,
I~ I Area Panachais Madina I I
I
, Both No. 8 2 10 %
Farming No. 81 47 %
Trade/shop No. 7 1 8 %
I
i
Unknown No. 10 %
TOTAL
I
I , ~
I
No. 106 50 156
%
76.4 94.0 82.1
6.6 2.0 5.1
7.6 4.0 6.4
9.4
100.0 100.0 100.0
10
! TOTAL -
9.4
\J1 N
128 ----
Table 11 - Number of responses on type of crops produced Paoachais and Madina areas, 1980
~. rops Area
Coconuts I Buai No. %
Cocoal Buasi ..
Coconuts I Cocoa %
Coconuts I Cocoa/Buasi No. 28 19 47 %
Coconuts or Cocoa
Unknown %
I i %
TOTAL %
No. 1 2
No. 59 15 74
%
No. 8 13 21
No. 9
Panachais Madina
1 1
0.9 2.0 1.3
0.9 4.0 1.9
55.7 30.0 47.4
26.4 38.0 30.1
7.6 26.0 l3.5
8.5
I I
1 No. I I 106 ! I I
i I ; i
100.0 100.0
I
I
9
5.8
I I
,
50 156
I I
..., \.II
I
I
TOTAL
I
I
2
I
3
100'°1
•
I
"d III
(JQ /1)
> ::s ::s /1) ~
N
NW
'0 :0Il> )j OQ )j
n> ro
Table 12 - Number of families with different. type of livestocks in Panachais and Madina areas, 1980
N ...., ....,
>:
r------. Livestock I Area -______. , Panachais
p~gs
chickens No. 45 33 %
I I
pigs only No. 27 6 %
I i :
chicken only No. 19
! , ,
None
! ! i
TOTAL No. 106 50 %
I I
!
,
% I I
No. 15 5
%
i I
42.5 66.0
25.5 I
17.9 12.0
14.1 10.0
100.0 100.0
i I I
I , I
Madina
12.0
I
6
i
i I ,
I i
I I
'J> .~
I I
TOTAL
78
50.0
33
21.2
I
25
16.0
20
12.8
156
100.0
!
Table 13 - Number of responses on commonly used means of transport Panachais and Madina areas, 1980
~ Area Panachais Madina
ransport
own/group or hired car No. 7 10 %
relies on . other's car No. 82 35 %
walk/hitch hike No. 17 5
TOTAL No. 106 50 %
! ! I
! I
%
6.6 20.0
77 .4 70.0
16.0 10.0
100.0 100.0 VI VI
I TOTAL 17 10.9 117 75.0 ---
I
22
14.1
I
156
100.0
." > II> i:l oqi:l t1) t1)
N:< -I'-W
~ ()Q
" 11) N
;.::l
::s 11)
Table 14 - Number of responses on ownership of radio Panachais and Madina, 1980
~
V1W
~ Area No. Panachais Madina 44 35
Yes %
I No. 62 15 41.5 70.0
No %
, No. 106 50
TOTAL %
I I 100.0 100.0
58.5 30.0
V1
~
TOTAL
79
50.6
77
49.4
156
100.0 -~
Table 15 - Number of responses on commonly used stores Panachais and Madina areas, 1980
~ Area Panachais Mad ina
Village stores No. 68 15 %
Town stores No. 11 %
Both stores No. 27 32 % No.
TOTAL %
64.2 30.0
10.4 6.0
25.4 64.0
106 50
100.0 100.0
3
TOTAL
83
53.2
14
9.0
59
37.8
156 -
100.0
I I
~,
"
III :s ()Q;:I (1) f1) )(
~!;..
N Cl',W
~I;J> II> ::l
Table 16 - Number of responses on use of gardening* Panachais and Madina, 1980
~Ig )( ~
..... v>
~' Use f o r · Area
, . For fam11y use No. %
For sale and family use No. 63 %
I
Unknown No. 3 1
TOTAL %
I , % .
No. 106
I I i I
Panachais Madina
40 21
37.7 42.0
59.4 56.0
2.9 2.0
100.0 100.0
I
, ,
28
50
I
I I
00
'"
TOTAL
I \ ,
61
39.1
91
58.3
4
2.6
156
100.0
I I I
I
*All families surveyed in both project areas have some form of gardening.
Table 17 - Number of families with church-going by frequency Panachais and Madina, 1980
I I I
~ Area
Once a week No. 73
I
Bi-week1y No. 5
Sometimes %
Never %
TOTAL % I
! I %
, i
%
No. 26 20
I I , I
I
I
I 2
I
No.
No.
i I
I 1.9 4.0
Panachais Madina
I
I I I j I
68.9 46.0
4.7 10.0
24.S 40.0
I I , I , , !
I I
106 50
100.0 I , 100.0
23
I !
I
5
2
I , I i
'.,/l
-c
i
TOTAL
96
61.4
I
I
i
10
6.4
!
46
29.S
!
4
2.7
156
100.0
,
~ ~ N
'0 ID ::J
>
:<
~w
'd
~
III :::l
:>
;
Table 18 - Health conditions by village in Panachais Project Area, 1980
tv '-Ow
><:
~ Health conditlilns No. of persons with health problellJS No. of persons without health problems No. of persons not examined TOTAL
Belifu 1 and 2 No. 69 %
Laefu No. 66 %
I
Namasa1ang No. %
Panamecho No. 52 %
Pangaefua No. 26 %
Usi! No. 35 %
TOTAL No. 281 % I
33.0
62.9
I I
I 33 32.4 31.0 22.8 38.9 35.7
I 44 43.1 70 41.7 66 57.9 33 36.7 331 42.0
82
39.2
36
34.3
i I
o '"
I , 58 209 27.8 100.0 3 105 2.8 100.0 25 102 24.5 100.0 46 168 27.3 100.0 22 114 19.3 100.0 I
22 90
24.4 100.0 I
176 788
22.3 , 100.0
T , I
I i
; No. of health probleUll;V No. of persons with I health problems
I 1.58 1.58 1. 73
1.44
1.38
1.40
1.53
I
I No. of health problems' I , Population -_._---
0.52
! .---I
0.99
0.56
0.45
0.32
0.54 -
0.55 .
--
Table 19 - Health conditions by age groups Panachais Project Area, 1980
Conditions -___ ~
Under 1 year No. %
Over 1 year to 5 years No. %
Over 5 years to 15 years No. %
Over 15 years and adults No. %
, TOTAL No. %
People with health problems
6
21.4
31
48.4
85
30.5
159
38.1
281
35.7 : 0"~
Iheal People without prob 1erns th
I 21 1 28 75.0 3.6 100.0 28 5
43.8 7.8 100.0
Unknown TOTAL
I I I , I
106 88 279
38.0 31.5 100.0
176 82 417
42.2 19.7 100.0 I
331 176 788
42.0 i
!
64
I I I
I
22.3 100.0
l
::Q
::l ~I> ::l :II
f1>
f1>
~Iw
><
--:l
Table 20 - Number ,of health problems in villages by conditions in Panachais Project Areas, 1980
'JQ ::J 111 111
II>
='
>
W
><
..... w
~th Villa2e
_._
~_
problems I ----. !
I Eyes 'Ears !
, I
~/ong~u
L' ~ps
Spleen
Teeth
I i
Skin
Glands
i I Anemia
ver L5t.:. Bo
II
nes
Cough
TOTAL :
I
Belifu
ILaefu 1Namasalang : Panamecho
I I I
I j
I
I
'I 10 1 I,'
!
!
23 7
iIi
!
I
6 4
24' 26 9
28 33 12
'
5 13 9
I
I
i
6 2 2 0 0 3
3 1 0
13
i 1 I
I
i
3 4 6 2 0 2
,
109 104 57 75
,i
I I
I I i •
8; 13 3' 14
4 3 5 0
1! 2 0 0
6
I ;
,
1 I
i
Pangaefua
;
I I !
1 1
I I
31 15 ' 17 9
I I I I
I
a,' 00
6 14
I I
6 0
2. 4 1
36; 49 I J
I Usil
, TOTAL % __
i
IiI 68
5! 38 I
I
!
i
.~__15._8__~1_6.0 ___L~~3
I
i
26
14!
I 1~.~ _I 19
~! I 116 ;
108
13
I ! I 11 I
I
4.4.
I~5~ t~~~__
3.0
I
17
2 . 6 : 4.0
. (lOO.O~J I
430
: j I
i
Table 21 - Number of health problems in different age groups by conditions, Panachais Project Area, 1980
T I
Village
Eyes
Ears
, -'
I Snleen I Teeth
Skin 50.0 3
Glands
I A I
nem~a
.
~//Bones ! Cough I
TOTAL 100.0 6
i
% 16.4 !under 1 year i
I I : I
33.3 2
1 I ,
jOver 1 year to 115 years i , I
1% i
15.6 7
4.5 2
4.5 2
8.9 4
4.2 2
37.8 17
11.1 ' 5
2.2 1
6.7 3
4.5 2
100.0 45 0\ Vl
I 1% 10.6 14 9.8 13 4.6 , 1
lOver 5 years to :15 years
2.3 3
6.1 8
10.6 14 40.5
31.8 42 18.6
21.2
2.3 3 3.6 9 !
5.3 7 3.3 8 2.4 6
100.0 132 100.0 247 ;
28 2.0 5 -
1% , 18.6 Over 15 years I
!
3.6 9
2.8 7
46
11
I 26 1
I
\
TOTAL 1% I
68 15.8
I I I
14
I I
,
i
6.0
I i
3.3
I
!
I
19 4.4
! I !
100
i
46
116 27.0
I 108 25.1
I I
I
I
38 8.8
13 3.0
11 2.6
17 4.0
I I
i
430
I ~ N
I I
,
100.0 ~
g (1)
x w
Tab1e23 - Number of different categories of health problems by age Madina, 1980
p.ro~s
~Age group I -_____..
Under 1 year No. %
Health prob1em:L----
Over 1 year to 5 years
Over 5 years to 15 years % ,
Over 15 years and adults No. 20 6 3 %
, ,
TOTAL
, Eye Ear
I
! Lips/tongue Spleen I
I I I I ,
-
-
I I
No. 1
No. 1
%
No.
%
I
7.1
2.4
23.8 7.1 3.6
-
-
14.3
-
2
I i I 1
I
Teeth Skin Glands
I ! , i
-
I i I 1 I
1 5 29 4
2.4 11.9 69.0 9.5 4.8
I ! ,
22 6
15.7 4.3 2.1 2.1 24.3 40.0 4.3 1.4 2.1 3.7 100.0
! 0'>
i ,
I I
3 3 34 56 6
29 18 1
- I 34.5 21.4 1.2
'"
I , , I
I
I I I , 1
9 1
64.4 7.1
I I I
,
, I
, Anemia Liver/bones Cough TOTAL
\
t
0
- , ! - I j - I I
I
1
7.1
I i
2
2 5 84
2.4 6.0 100.0
, I
• i
2 3
I
•
-
I I i
14
100.0.
I
42
100.0
I
5 140
:JQ (II
" > I» ::s (II
, I
I
::s ~
I
w
.;:-ow
-.:1> I» P OIl
Table 24 - Number of responses on knowledge/beliefs in causes of illness Panachais and Madina areas, 1980
Ulw
no !D :< w
::t
~ Area
'lInes! No.
Germ %
God's punishment Evil spirit No. %
Combination of all of these %
Do not know No. %
TOTAL No. %
, Panachais Madina
No.
No.
%
, 41.5 58.0 9 1
44 29
R.5 2.0
I I I !
I
26 5
24.5 10.0
18 9
17.0 18.0
9 6
8,5 12.0
106
100.0 100.0
I I
I I
50
i
I I
I
'" '"
I
TOTAL
_________ 1
I
73
46.8
10 ---
6.4
31
19.9
27
17.3
~----------_L..----
I
15
9.6
I
I
156
100.0
Table 25 - Number of responses on beliefs in taboo foods for pregnant women, Panachais and Madina areas, 1980
~--
~~ Area Panachais Madina
Certain type of* big fish~ e.g. shark mali sa No. 89 35 %
Popo, certain kaikai No. 7 3 %
Have no taboos No. 4 12 3.8 24.0 %
Unknown No. 6 %
TOTAL No. 106 50
---i % I I
I I
84.0 70.0
6.6 6.0
5.6
100.0 100.0
-
-
I I
TOTAL
124
79.5
10
6.4
16
10.2
6
3.9
156
100.0
I
......
'"
*16 responses in this category also believes that pork is taboo foods for pregnant women.
~
" ::s :.:til
g
"'w
w ><
'"d
Table 26 - Number of responses on experience of illness in family during a week, Panachais and Madina, 1980
~ ID W
5 ID
:>
><
..... <.,)
~-
--
~ Area No. Panachais Madina 59 32
None %
1 or 2 persons No. 38 15 %
3 persons or more No. 7 3 %
Unknown No. 2 %
TOTAL No. 106 50 %
55.7 64.0
35.8 30.0
6.6 6.0
1.9
100.0 100.0 a00
2
1.3
TOTAL
91
58.3
53
34.0
10
6.4
156
100.0
\
\
Table 27 - Number of responses on experience of Malaria in family Panachais and Madina areas, 1980 ..
~~ Area Panachais Madina
, Yes No. 55 23 %
ma1ari
No No. 48 27 %
Unknown No. 3 %
TOTAL No. 106 50 %
I ! I
51.9 46.0
45.3 54.0
2.8 0
100.0 I ! 100.0
3
I I I
i TOTAL J
0"-
\C
78
56.0
75
48.1
1.9
156
100.0
!
"
.:10 ::I (1) (1)
;..III ::I ':X>w W
X
Table 28 - Number of responses on infant's age of first supplementary foods Panachais and Madina, 1980
." I» IlQ (1)
::s ::s (1)
:.:-
\Ow
W
><
Age ~Area
~--
Before 3 months old No. %
3 to 6 months No. 53 26
After 6 months %
Unknown 10. %
TOTAL
No. 28 11
%
No.
%
Panachais Had ina
17
16.0 4.0
50.0 52.0
26.4 22.0
8 11
7.6 22.0
106 50
100.0 100.0
2
..... o
TOTAL
19
12.2
79
50.6
39
25.0
19
12.2
156
100.0
Table 29 - Number of responses on first contact person at the time of illness Panachais and Madina, 1980
~. Area tact- rsotl
Traditional Healers No. %
Village chiefs, . family elders No. 22 11 %
I ,
Church No. 11
Health centre %
Aid post No. 59 30 %
TOTAL No. %
I ! I
No. 3 I .
%
Panachais Madina
11
10.4 6.0
20.8 22.0
10.4 10.0
2.8 2.0
55.6 60.6
I I I
106 50
100.0 I
I 100.0
3
5
1
I I I .
--J
I
TOTAL
14
9.0
34
21.2
16
10.2
4
2.5
89
60.0
156
100.0 , ,
j
'" ::l ()Q (I) ~
" > " (I)
><
Ow
% 50
r Key: ~
r===J ~
Registered pop. Resident pop.
II> g" :l OQ
CD
CD
251
.p-
~
~ Study pop.
.....
w
20
15. ...., N
10
01
I
C\)QQ()(~
b.$XMQI Laefu
b'\KMtx)I Namasa1ang
l'\YMOOO Panamecho
Belifu 1 & 2
I\.\(XX,MJ Pangaefua
1\1)QW:NI Us 11
VILLAGES FIGURE 1. POPULATIONS OF REGISTERED, RESIDENT AND SURVEYED IN PANACHAIS PROJECT AREA BY VILLAGES, 1980
PAHACHAIS AREA
MADINA AREA
61.3 _ bush materials iron roofing
~.o
•
iron roofing
28.0 _ bush materials
-..J
v.>
FIGURE
2. HOUSING MATERIALS OF VILLAGERS IN PANACHAIS AND MADINA PROJECT AREAS, 1980 SURVEY
'" > III =' ')Q =' (I) (I) ~~ Nv.>
'80 " Key:
P ~
Panachais area Madina area
~
~i
>
..,..~ WI.>
.....
~
2
1
River water
Spring water
Communi ty tanks
Private tanks
Combinations
FIGURE
3.
TYPE OF WATER SUPPLIES IN PANACHAIS AND MADINA PROJECT AREAS SURVEYED IN 1980
PAHACHAIS AREA N .. 106
MADINA AREA N
= 50
94.0 % Fal"llling Farming
76.4 %
V1
.....
FIGURE 4 •
SOURCES OF LIVELIHOOD IN PAMACIlAIS "lID MADINA PROJEX:'!' AREAS,
1960 SURVEY
0> Ill. ::I '" II) ,::I II) J>-~ ~w
% 70 Key:
P
Panachais area
" > Pl ::l ]Q ::l I1l I1l
p.><
60
~ Madina area
VlVJ
50
40 ~
20
10
oI FIGURE 5..
I
1\'\ '\ '\
1
I
t.\ \ \ \ \I
I
I
1,\ '\ \ \
I
Pigs aDd chickens
Pigs only
Chickens only CMm)
I n \\"\ I No livestocks
PERCEIfl'AGE OF FAMILIES WITH DIPFEftEIIrl' LIVESTO(lKS
IN PANACHAIS AND MADINA PROJEX:T AREA, 1980
Panachais Area
Madina Area
77.4'1> relies on other's
70.0
'I>
relies on oti,er' s car
" "
FIGURE
6,
PERCENrAGE OF RESPONSES ON COMMONLY USED MEANS OF TRANSPORT BY VILLAGERS IN PANACHAIS AND MADINP AREAS
1980 -oj ;...
III ::I '<l ::I rt> (1)
.p-
>:
0-.''->
'0
% 70 Key:
Q> ::l
~
(]Q (\l
:::l
ro
CJ Panachais area ~ Madina area
. . . ,w
~x
60
..., 00
20
0, FIGURE 7.
I
1\),),),,>'\1
I
1'\'\'>'>'>).1
Village stores
Town stores TYPE OF srORES
Both stores
I" . . . . . . . .
J
PERCEm'AGE OF RESPONSES ON MOST CCJ4MONLY USED sroRES, PANACHAIS AND MADINA AREAS, 1960
Panachais area
Madlna area
37.7 % for family use
59.l!.
%
42.0
%
56.0 % for sale and family use ....,
for sale and family use
for family
.c
N "" 106 families FIGURE 8. PERCENl'AGE OF RESPONSES ON USE OF GARDENIlil IN PANACHAIS AND MADIMA PROJECT AREAS, 1980 ",I:: rorro oJ'
>
":11'" ::t)~w
::-'':.:
~o '" :0Il> ::s IJQ
Key:
c=J ~
Panachais area Madlna area
III III >!
::s
..,..
\Ow
60
50
~O
.~
(Xl
o
20
10
0,
once a week
"'>"1
I
1),,)"1
hi-weekly
sometimes
'>'>"
never
IS'''']
FREQUEM::Y OF CHURCH GOllii FIGURE 9. PERCENI'AGE OF RESPONSES ON ~UENCY OF CHURCH-GOING, PANACHAIS AND MADINA AREAS, 1980
FIGURE 10. HEA:'TH ::~NDITIONS OP POPULATION SURVE'{EI) 3Y '/IILAGE IN PANACHAIS AREA, 1560
70 Key:
U
Peop1" without health oroblerrs
60
~ Peopl'?
with heal th Drab lelPs
5 iii 0
~ [iI
<C
ffi
rYV\J 4
:>:> ,.....
p.,
3 ,~ .... f' "
":'". "' • I
\ ;, .......
I
~.-:':; f ' . I., •• , .'" '. -.,.-. ,4.1 ".
. .. .. \0., •
.,.', ,. 1.°, I •
:.~ ",.
':." .. ,
~;.,.:
, ..... • , I
!.
tt.:., •• , J, .. :
.'.., ."". "" -. • •
_I ,
•' / , J •
: -,... '. ':.
.. ' : . •••••
. . ".': .....
•• " •• '
C>
~I'::-..
..
:
","
::"": Namalalang VIILAGE
a •
~ t'anamecho
-;:)1>
"'I§ X
(;) (1)
w
Laefu
Pangaefua
Usil
%
'lc Key: I;:~::·;.I wi thout health orob lems
~ with 701
health problems
III 'lQ (1)
"
(1)
::l ::l ~
:>-
CJ
......
VI
w
Unknown
40
30 Cf:)
"..l 20
10
0,
"'·0:;;-"'»""1 Under 1
11'-:.- •
Over 1
.,~~ 'I(
to 5
'-.. e'" , \ l AGE IN YEARS
......
Over 5 to 15
-ifi).""
t·-~,
..""y All ages
FIGURE 11. HZALTH CONDITIONS OF DIFFEREHI' AGE GROUPS. PANACHAIS PROJEC"I' AREA,
1980 C<lt1MUNITY SURVEY
27f> problems with teeth and gums
A total of' 430 health problems out of 612 examined :x> VJ
25.1 f> infections
FIGURE 12. PERCENTAGE OF HEALTH PROBIa>1S BY CONDITIONS, PANACHAIS PROJECT AREA
":l
1980
.:-:1 ;:l I1l ;'>.J '"
'-'
;:l
:>
I1l
X .......;
Key: ~Over 1-5years(N..64, 45 H. problems) ~
tj~$t.ilOver 5-15 years (Na191. 132 H.problems) c:::JOver 15 years (N-335 , 247 H.problems)
~ ~
t:I II>
::s
>
\J1>1
50
ww
40
30.
00
"""
1
Sk:f,n
Eyes
Spleen
Glands
Teeth/guns
Cough/ears PR~
FIGURE 13.
PERCENl'AGE OF HEALTH PROBLEMS IN DIFFERENT AGE GROUPS BY CONDITIONS, PANACHAIS
AREA, 1980
46.6 tJ, peopl e witho ut healt h proble ms
47.0 tJ, peopl e with one or more healt h proble ms Ion
CD
H PROBLEMS FIGURE 14. PERCENrAGE OF PEOPLE WITH AND WITHot11' lIEALT MADINA PROJECT AREA, 1980
:> "" ill :::I ~
g ~
V1
~w
40.0 ~
"'I> Ijg ~ \II VI)C VI...,
::t
skin proble ms
~pe",ons of all . .e,
A total of 140 healt h proble ms out of
4.3
~
gland s
, examined
15.7
~ ~
proble ms with eyes
proble ms wi 1;h an:: guns
FIGURE 15. PERCEm'AGE HEALTH PROBLEMS IN ALL AGES BY COND ITIONS, MADINA PRo.m::T AREA, 1960
23. 8
~
with eyes
A total of 84 health problems out of 21.4 ~ -..,J
::c
34.5 ~ wi th tee,th and gums
-::l
FIGURE 16 • PERCENTAGE OF HEALTH PROBLEMS IN AGE GROUP OF OVER 15 YEARS OLD BY CONDITIONS, MADINA PROJECT AREA, 1960
'J<l ::l II> II>
III 0
>
\.11>< O'\w
~
PI ::J OQ::J
"d
>
!II !II
v.>< " w
14.3
%
A total of 14 healt h proble ms out of 22 child ren ged 1 to 5 years examined 00 00
64.4 % skin problems
I
FIGURE 17, PERCENl'AGE OF REALl'H PROBLFl4S IN AGE GROUP OF 1 TO 5 YEARS BY CONDITIONS, MADINA PROJECT AREA, 1980
% ms
69.0 % skin proble ms
A total of 42 healt h proble ms out of 74 child ren exami ned
00
-c
OF OVER 5 YEARS TO 15 YEARS FIGURE IS.PERCENTAGE OF HEALTH PROBLEMS IN AGE GROUP BY CONDITIONS. Mf..DINA PROJECT AREA. 1980
-::; > Siro
21 5 ::X>w
y+
Panao hais area
Madina area
'" ::s "dl:' > 'D CD 'l'l \J1
X
-Dw
24.5
~
evil spiri t
58.0
~
germs
41.5 germs
~
-D
o
N- la) FIGURE 19. PERCENl'AGE OF RESPONSES ONbtowIBOOEjBELIBPS IN CAUSE S OF ILLNESS, PANACHAIS AND MADINA AREAS
1980
Panachais area
Madina area
70.0 %
'cert.ain t.ype of big fishes, ego sharks, malisa ~.O ~
certain type of big fishes. ego shark malisa
......
-.c
N - 106
N
= 56
FIGURE 20. PERCENl'AGE OF RESPONSES ON ~IliFS IN TABOO FOODS FOR PREGNANT W<»1EN, PANACHAIS AND MADINA PROJECT AREAS, 1980
;c ';:l -, l;:l
-::1»
~I~
de,..;
% 70 T
" > Ql ::I
60 Key:
OQ (1)
::I
(1)
a- X ..... w
P ~
Panachais area Medina area
50
_0 \0
30
'"
10
0,
'\'),\'
"),),'\),, 1 or 2 persons ill
I
''\'''\'' 3 persons or more 111
FIGURE 21.
PERCENl'AGE OF RESPONSES ON EXPERIE~ OF IILNESS IN FAMILY DURINJ PAsr WEEK, PANACHAIS
AND MADIRA PROJECT AREA,
1980
PANACHAIS AREA
MADINA AREA
26.4 % after 6 months
4 % befure 3\ months.
22
%
unknown
50 % between 3 and 6 months
w
-.c
52
~
between 3 and 6 months
FIGURE 22.
PERCENTAGE OF RESPONSES ON INFANT I S AGE OF FIRST SUPPIDlliNTARY FOODS INTRODUCED PANACHAIS AND MADINA, 1980
.",> 0<1
:u ::s
II> II>
::s
0-)(
Nw
Key: ~
c::J
Panaohals area
"d
> ~
60
~ MadiDa area
0:
'" ::I
~M
ww
50
'D ~
1.0
o,
Tradi tiona1 healers
'"
""I
I
1\\ \ \ , )
Village chiefs, family elders
I 1\\\\\1 Ch\ll"Ches/gods
I TO •
~)01 .c.
~
h.'0\,\1
FIGURE 23.
PERCENTAGE OF RESPONSES ON PIR3r CONTACT PERSON AT THE TIME OF IUMESS. PANACHAIS AlID MADlKA
1980
- 95/96 Annex 3
DEPARTMENT OF NEW IRELAND DIVISION OF HEALTH KAVIENG PR~Y
HEALTH CARE SECTION
Simple Survey Form For Problem Analyses WEST lARA - NALIK ELECTORATE
Prepared by staff of the Provincial Health Office
:
Directed by Dr L. Sialis, Provincial Health Officer
Annex 3 Date: Family Code No.: Name of vi 11 age : Family AGE SEX P.ELATIO~ EDUC OCCUP. Eves 1 2 Profil~
Interviewer: STATU 5 Skin illoM.s Tot. Wt. Ht Remarks COIIJI) Inmress.
NO.
NAME
HEALTH
Ears
LiD. TonStue Teeth Glands Liver s"leen
3 4 5 .
6
7 8 9
:k.
10 11
--'" I
12 13 14 Total MeH information: (1) (2) (3) (4) *Put
How How How How
many many many many
miscarriages? -=..--;;________ children born alive? _ _ _ _ _ __ children died? _....,....._ _ _ _ __ children at present1
Died at what age?
year _ _ year _ _ _ year _ _ __
*
only for posi ti ve sign
*Use coding for complaints, e.g- F for fever, D for diarrhoea, etc.
- 99 SIMPLE COMMUNITY FORM
Annex 3 ----
VILLAGE:
DATE: INTJo."'RV IEWER:
FAMILY NAME: HOUSE NUMBER: INSTRUCTION: I. I'lea~le
tick only one item which you think
IS
most appropriate.
PHYSICAL ENV IRONMENT 1. What is the building materials of your house? (a) (b) (c) bush and timber bush materials timber/iron roofing
2.
How do you get your water supplies? (a) (b) (c)
river common spring private spring common tank private tank drum
(d) (e) (f)
3.
Do you have toilet? (a) (b) Yes No
4.
Where do you dispose rubbish? (a) (b) (c) dump them any place burry or burn them in rubbish hole
5.
Do you have vegetable garden? (a) (b) Yes No
6.
What do you grow in your garden? (a) (b) (c)
taro, sweet potato or banana beans, peanut and greens frui ts
7.
If you have vegetable garden, what do you use them for? (a) (b) (c) for family food for sale for family food and sale
- 100 -
Annex 3 8.
Do you have any livestock? Chicken (a) Yes
Ducks (Yes) (No)
Cattle (Yes) (No)
(Yes) (No)
(b) No
9.
If you have livestock, do you keep them in pen? (Yes) (No)
II.
ECONOMIC CONDITIONS 10. wnat is your source of livelihood? (a) agriculture
(b) employment (c) private trade
(d) coubined 11.
If it is agriculture, what kind of crops do you have? (Tick all the items of crops you grow) (a) coffee (b) cocoa (c) vegetable
(d) rubber (e) fruits and nuts (f) betelnuts
(g) coconut 12. If you grow more than one kind of cash crops, what is your main crop? Please tell me the order of important cash crops from number 1 to 4.
(a) coffee (b) cocoa (c) vegetable
(d) rubber (e) fruits and nuts (f) betelnuts
(g) coconuts 13. How many livestocks do you have for each of the following? (Write number of live stocks for each) (a) pigs
(b) cattle (c)
chicken
(d) ducks
- 101 -
Annex 3
14.
Do you have any cash income? If you do, how much in a month and in a year? (Write average cash income for month, and year) •
-----Kina -----15.
Kina
(a) Average monthly cash income. (b) Average annual cash income.
Which of the following is the main source of your cash income? (Please number from 1 to 4 inorder of important source) • (a) trade (b) wage (c) selling of cash crops and livestocks (d) betelnuts and mustard
16.
If your sources of income include the following, how much does it come from each source? Kina Kina Kina Kina Kina (a) coconuts (b) coffee (c) cocoa (d) livestocks (pigs, cattle, chicken,
etc. ) (e) rubber
III. FAMILY EXPENDITURES 17. How much do your family spend on each of the following items in a week, a month and year. (Please write approximate amount of kina for each item for a week, a month and a year) • Weekly Kina Kina Kina Kina Kina Kina Kina Kina Kina Monthly Kina Kina Kina Kina Kina Kina Kina . Kina Kina
Yearly Kina Kina Kina Kina Kina Kina Kina Kina Kina (a) grocery (food) (b) clothing (c) lamp, kerosene
(d) education (e) medical expense (f) social obligatio
(g) smoking (h) drinking (i)
otherH (specify)
- 102 Ann.x 3
18.
For the social obligation of your family, how much do you roughly spend on each of the following items in a year? Kina Kina Kina Kina Kina Kina Kina (a) merit (b) feast/sinsing (c) funeral (d) church (I;!) bridl;! price
(f) rl;!crl;!ation
(g) fishing/hunting
IV.
HEALTH ATTITUDE/BEHAVIOURS/TRADITIONAL
19.
For thl;! medical expenses of your family, how much do you spend on each place of the following every year. Please write amount of Kina spend in a year at each of the following:
-----Kina -----Kina -----20. CHILD HEALTH
Kina
(a) hospi tal (b) tradi tiona1 medicine man (c) other (specify)
Do you attend MCH clinic? (a) Yes (b) No How often? (a) regularly (b) sometimes (c) never
21.
If your wife is pregnant, where do you prefer her to deliver? (a) at home (b) at the aid post
(c) at health centre
22.
How do you think a person get sick? (Please tick one time of the following only) (a) germs (b) pllnishment of Gnd (c) ('vil spirits J~('t (d) illto rt [H'rsnll
combin<J[ior. 01 III(' "hoVl' rrx'ntiorwc/
(e) sorcery (f)
I do not know
23.
Annex 3 When your family member is sick, from who do you get help first? (Please tick only one item) (a) traditional medicine man (b) aid post orderly (c) health centre (d) family (grand mother, father)
- 103 -
(e) village chief or elders (f) church
(g) others 24. Does a pregnant woman have taboos for foods? (Please tick (II") appropriate items i f more than one. (a) cassowary (meat) (b) certain vegetables and greens (c) totem
25.
For your last born child when did you first start to give supplementary food? (Please tick (~) only one of the following) . (a) 3-6 months old (b) (c)
6-9 months old 9-12 months old
(d) be fore 3 months old (d) after one year old 26. Does your family have a radio? Listen to the programme regularly? (Please tick ( .... ) one. (a) (b)
Yes No
27.
llo you read newspapt'r or magazine?
(Please tick (or')
only one. (a) every week (b) at least once a month (c) occassionally (d) never read 28. Do you come to Popondetta often? only one. (Please tick (~
(a) once a week (b) once every forthnight (c) more often (d) never
- 104 Annex 3 29.
\.bere do your family buy rice or other food. one important only. (a) village store
(Tick (,/)
(b) store in Popondetta CON!) ITION OF THE ROAD
30.
Are you excess to the road? (a) Yes (b) No
What type of road? (a) track (b) M. V. road (c) others (specify)
31.
How do you get transport when you go to Popondetta or other places? (Please tick only one important item). (a) family car (b) get a ride on P.M.V.s (c) walk or hi tch hike (d) family bicycle (e) other means (specify)
32.
Do you and your family go to church? (Please tick only one).
How often?
(a) every Sunday
(b) once a while (c) never
33.
Any of your family members sick with malaria during las t month? (Tick one) (a) Yes
(b) No
34.
How many members of your family have been sick during this month. (Tick one only) (a) more (b) 1-2 persons (c) 3-4 persons
(d) everybody
flUBRAft1E Fill R£ PROJECT IN PAl\!ACHAIS AND MADH" AREAS 1981 PLAN IF ACTIVITIES 5O£DUL£ t'HlUUTY (J\i
ANNEX.4A
I'HVSlCAL ENVIRD'H:NT IN RmARD5 TO I£ALTH - ---
(VILLAGE DEVELOPMENT ASPECT)
Ill.:ECTI lIE
TAfEET
PRIllLEM 1. BUILDIN3 MATERIALS Lack of better Housir-g To ilTprove better housing Bush materials Iron roof-
ACTIVITIES
--PERSIN£L RESPrn5I8IUTIES
REEIlJlCE5
1lAl£5 Art) H(J\iTHS
_1'05
VDC. Heeti ng canpaign for: - Better Housing - Fund Raising - Check Progresa
Indivililal bers
voc.
~
VDC/lIIBflIObEr, VIlC - group purchase, tion from Provincisl [ioverrnent
1st VOC Meeting Nov. 1960 then; UaeCOlllTl.days Monday and Friday
~prU 1961 Reports on meet
1ng
- 2 Reps from each village
technicsl alildn1& 3 monthly
ing 81d
c""",,i~ n
success.
2. b1ATER SLJ'PLV Poor quality and quantity
To ill'p1'OV1'! water aupply system Increase large containers. Shoe of tanks
Panekais - 14 (2000 gal.) 1DIIIl.
Cont: VDC Meeting - Fund Raising - Install indiviliIal and com"","ity tanks.
Sane as Above
lIIHo, P.H. Office and VOC. Families, Council
Start April 1981
f!!:!!... - Health Office Staff - VOC and Health/ inspector to Decide site for installation
tanks
~-2
.
H/lnapector and VDC to check February 1961
.... 0 '" I
I
(2000 ga1.) r:mII1.
tanks
3. TOILETS
Lsck of toUet 9
To ill'p1'OV1'! and increase touet fscili ties.
To starting building toilets Jan.April 1981. Elilcation
vee ion -
Meeting Acttoi-
- VOC
Materials ( 1) Bush
Conmence from Jan-April 1961
At VDC, report on progreBB
- C/WOC - Hllnspector - Healt h Staff
~lete
(11) Permanent
let bui lding - Health Educ.
..
Annex 4A
f'RIIJUTV f'R[lJl.EM
03.ICTIVE
TAR>ET .
ACTIVITIES
f'ERS(N£L
RESWa:S
DATES Al'I>
REIt\RI"S
RESP£HlIBIUTIES
4 fARHIN:i Lack of sufficient
To introwce garden projecta
Initiate Dem:lnstration Garden Projects 1981
\/DC Heati'll Action
- \/DC
salable vegetables
- QqJlate g!lJ'den fence clear ground
- Hospital Task force
- VIlC - Wire -Seeds
Nov. 198J
Work out time table with DPI for tee/mical advice coordinate d by Provi nci al Nutri tioniat.
.:an -
Dec. 1981
- DPI - I'&rt:ritioniat E)(pertise
- Plant - Cultivate 5 UVE STlI:K - Lack of Pig and
To encourage pig and chicken fenci'll.
Each village to increase fencing
- \/DC Heati'll
VUlegars
Villages \/DC
start
chicken fenci'll - Destroyl'll agriculture
- Campaigns - Get rid of big pigs - l'eep small pigs in fencea ~lete
DPI Health Staff
.:an -
Dec. 1981
VDC - reports on progress
~
Radio
fenci'll
Health Ewc. - on advantages 6
CRASH CAlF
Depends entirely on Nature. Needs DPI for cocoa. Labour for Production ---- -------------
TRANSPrnT
LONG
RANGE
PROBLEM
TIME TABLE FOR PANACIIAIS AND KADINA PIIC PROJECT ACTIVITIES HUVEHBER 1980 - DECEMBER 1981
Annex 4A
ACTIVITIES I.
NOV
DEC
JAN
FEB
MAR
APR
KAY
JlJIiE
JULY
AUG
SEPT
OCT
NOV
DEC
VDC MEETING l.
Water supply Livestock
2.
-
---
3.
Toilets Farming Building materials Cash crop
4. 5. 6.
-------
7.
Transport
-
---
-----
-----------
---
-
---
-
---
------------.... o .
-----
---
-
" '0 (J)
~
II.
CAMPAIGN 1. Fund raising for - Better housing - Water tanks
--i--.
----_I-
2.
Wj..re fen~ing f~_ pig~_
-
-
----
r---
--j.-
-
I'RIJiRAIot£ F!Jl PH: PRo.:ECT IN I'4IINAafUS AREA NOV. 1990 - DEC. 1981
ANNEX 48
(HEALTH SERVICE ASPECT) I'RI !JlI TV 1. LARGE number of village people affect ed by Malaria W.:ECTIIIES To oontrol 1. TARBET BROlJ' ACTIVITIES 1. I£ALTH EDUGATI~
PERSIMIEL/ RESP!JIlSIBIUTIES
REQUIRED RESCUUS DOT ) P.H.D.
DATES 12-1~1 19-1~1 2-3~1
REYARKS Spray Survey I:~ai!ln
PEIPLE • '+5 years old • nnthErs
Dlalaria
AND
GASE FUllING AM> TREATI£N'
. .
V.D.C + village people Spray teamlmalaria tesn from AiD.
Sprayer ) melaPosters ) ria team MediCines AP. + H.C. + PHIl
Action
8-81
2.
Environment
2. DOT SPRAY 3. DESTROY 1Ui-
QUITmi 8REEE ING AREAS 2. Too many people have To prevent, treat patient 2. people 1. 5-15 school children Adults 1. Treatment at A.P. end villages 2. Health Education 3. Caorpe1gn 2. 1. APO + H.C. ataff Medicine Sufficient water Poaters N.B.I: - Tok SSVE I ~
~algn
4 May 1981 Action 1B .lJne 1981
0 .., I
skin diseasea to educate
vee help APO/ H.C. case finding, ing. c~e1!ln-
3. Family members for horne treatment end hygiene 3. Too me"y people have eye infections and other eye To prevent! control and educate 1. 1-15 years old adults. 2. Teachera 1. Case finding 2. Treatment 3. Cmt>aign/HeaIth Education V.D.C. APO V.D.C. and Health Staff Hediclnes from A.P./H.I:./PHD village people buy sorne mediL1ae "ppo rtunity for Health Education \J'oen
I"CH sister
Annex 3
PRICfUTY
CIl.:£CTIVES
TAR;ET GRClJ'
ACTIVITIES
'PERSIN'£L./
REQUIRED
DATES
REMARKS
RESPIlIISIBIUnES problems Traditional healer cines use tradit10nal rredlcine 4. Too many teeth and mouth problems. o prevent dental routh hygiene 1. 5-15 years old school chlldren 2. Teachers 3. Parenta • Health EducaNutrition 2. Dent al Survey and Treatrrent at School Dental Officer/ Provincial Health Education Dental Officerl Provincial Health Educator Health Edue&tion Material provided by PIlE Required reaourcea would be provided by
corres to conduct 101 c11niea Dental Office r , PIlE will COll1l!
people heve problema pl'ClllOte
tion on Hygiene, P. Hospital
to vll-
leges 2X 1981
.... .... 0 I
I
Dental Officer 5. Many pregTo prevent 1. Pregnant women 2. School chilO1. Health Elilcation on aanitation, nutr1tion 2. Plant frul t trees Treatrrent n1ng Provinei al HeaIth Inspector APO + V.D.C. + f'Di sister PosterB~HE
nant mother! a.-em:l.a and proand chlldrer mote good have anemia health
FUms
ren
I ..
V.D.C. + village APO + 101, Slsters frOOl H.C./
Iron tablets from H. C/AiD/ AP
I
r" ,..u, ".,. I~" ,~ (R() -
r'
..
- -- - -
--~~
•
TIt£ TABI.£ FIR f'l\NACHAIS I't£ PRO.JEI:T ACTIVITIES IN 1981
Annex 4B
ACTIVITIES 1. V.D.C. ACTIVITIES
NOV.
DEC/BO
.:J\N.
FEB.
~.
ARl.
MAY .
.:LtIE
:u.y
AlE.
SEPT.
lET.
NOIJ.
DEC.
a) DDT Spray and Male ria Team b) lleatroy IIIDsqul to breeding areas
-- - - - --- -- - - -
~ ~
I
"' Glear-
,....
F SPRA'
Q£CK
L
. Cear1m. IE~v1ron-' ~nt
CHECK
19. JIB:
canpaig
~
Environ-
ment c) Ganpalgn !'or control of akin conditiona
- - -- - - -
-- - --- - ---
I't£ ~ IActlorJ WorkahoplQalg n coope(3 days) rate ~
---- --check
--
I't£ ~rk-
.... ....
health sts!'!' 2. PRIlVIM:IAL HEALTH STAFF a. I'8laria Team
I!hop
- - - - - ----- - --
!!!£...:g Survey DATA 19 ANALV-
b. Dental Health Of'ficar c. Provincial Health Educator
-- - - ---- - --
SIS I~chool Dentall Eye Hygiene
. ---- - ------ ----- - ---- - - -- -
.
~::rSRlA
I
I
,L ~tnolt Dentall Eye Hygiene
OPERATIIlII
. ~ye Hy-
EVAWATIIlII
- --- -
- - - - - - - lEichool, - - - - - - - pental! plene
Annex 4B
ACTIVITIES /MIl'lTH
NOlI.
DEC/SO
JAN.
FEB.
l'4AR.
APR.
~'iAV
.1I\E
.lJLV
ALG.
SEPT.
II:T •
NDV.
DEC.
3. 3)
~CDT
HEALTH CENTRE
MCH Sisters,' He and ~.cH/ PHD Conduct village clinic Health APO Training Health Educ2tion Hwlene Conduct village MCH clinic
-- - - - - -
- -- . - - - - - -
villaqe H. Educ. Clinic
---
H.C •....,vil- - - lage
-- - -- - Clinic H. Edue. Treatment
- - -- - - - -
I
Skin c11nics
~ ---
b)
,
Me NTHI v 1>1: fI r.1 TNT :s
AT V[LLAGES
~..r-
a)
4. Aid Pest Orderly Care of the sick at API villages b) Skin clinics c) Health Education at School
.
CI\R£ "£FTHE
MCJIITHLV REPCflT TO
1
SICK AT A.P.
RiO~
I
---
AN)
VILlAGES UKN NEEDED
.... .... N
---
. Records Reviewl
Skin c11- Dental nics Clinics at School Records Review
d) e)
Records/Reports Work with V.D.!:;. f't(;
"
RecorJl! Check
Records Revi,
Records RevieL'
5.
Project Workshop, RiOI
1lJi0
•
PROGRAMME FOR Pit: PROJECT IN MAD L~ AREA
NOV. 1980 - DEC. 1981
ANNEX 4C
(HEALTH SERV ICE ASPECT)
PRIOOTV PRllllEM 45% of village population under 15 years Table 2
OB.ICTIVES 1. To reduce nunbe of children bon per year. 2. To space nunber of children in a family.
TAIEET GROLl'
ACTIVITIES
PERS[J'(AL! RESP(]'j5IBILITIES 1. Family Planning Sister PHD ) APD VOC (village» ) APD FIP Sister ) Assist FIF Sister 1. VOC gatherings of parents 2. APO assist MCH Sister 3. MOH Sister/H.C. and Health Education and Demonatrati on 4. P.H. Ewcator 5. PHD Staff 6. UJomen's Group 1. Gommunity-Families 2. VDL ",embers 3. APIJ 4. H.C. steff 5. P.H. staff 6. Infor.etion E.G news paper 7. NBC
RESIlflCES All Contraceptive Methods
DATES/MCJlJTHS il1ce every 3/12 as above
REMARKS APD keeps recor ds at Aid Post
1. 2. 3. 4.
EDLCATICJIJ 1. Health Educatior Patients on Family PlanVillage Leaders ning and Women's Group 2. Family Planning 01e dey seminar at Village 3. l'eep records! to the above people involve. 3/12) Report 3 monthly 1. Health edueatior on suppll!JJ'entar\ feeding 2. Demonstration cooking on inrant food 3. Nutrition Seminar.
Lack of undsrstanding by mothers on ""'en to start feeding
Table 16
EDl£ATI (]\j 1. To conmence educational di~ 1. Mothers at 3-4 JTDntha 2. Womens Group 2. To prevent malnut rl tion rate among children under 5 years.
Mass Hedia-PHE Health Education Face to Face contact (Grease) Food for Cooking
14th .l..oly 1981 Health Education Demonstration 1st .l..one - SeminaT
VOC Tok Seve to parents/loIOI1ens group to bring Kaika! (food)
~
I
<I
1.6% of Medina population exp~r1ence malada sickness
Table 15
1. To control 2. To prevent 3. To develop each leader a sense of his i~ortance to the enti re progr<llllE BO that he can see iJ"lere his role is to the ,,111012 paterno
1. Community lea1. Health Eduestior ders individual 2. Spraying-Mass an~ families Drug Adm. 2. Breeding ground. 3. Seminar on role . 3. Malaria patient of VDC/village c. Village leaders leaders on M/ 5. VDC membera control
) PHD DDT Drugs ) Seminar materials from PRO H.D. and others ne..s paper + charts VDC pre;Jeres seminar place and necessar things.
20th September 19B1
8. Malaria Section) 9. Health Educ. 1 10. Teachers )
-.PHD
MADlNA PHC PROJECT ACTIVITIES 1961 Annex '-I.e
_P_R03_II~,
PRlDiITY
,.
.1 ,., ________ 1.
I
fJ8.JECnVE5
i FiffiET
GROJP
ACnVInES 1. Health Education 2. Short seminar on Health Problem 3. Treatment/clinie 2t ".llage 4. Dental clinic c8ll'lJaign 1. In service t 'oining ? T " monthly i "tory on drugs '. Re'J"lp- visit by"L 3tarr I
~CflAI./
RE5O.RCES
DATES/MCJ\ITIti
REMARKS
RESP()lSIHIllTIES : Idren and \.lIt ,C h 10 1 ehll dren t::achers 1. \/DC IlEmbers 2. ~ity and FaniUes 3. He9lth staff H.C. APO's 4. others - inforIIIIItlon on NBC Drug and dressirg - H.C. Aid Post Ai staff lllater and soap village Mass Media - infol'llElUon and NEIL
HE21th St3t.JS! To ~T'eat 1. Skin " '1 I '. To c-,trol an,1
___'_' 'I'. ;~~' A.
2. Teet'·, .3~, preve. 3. Eyes ~' ,"" ,3. T"
I
2. d'
~~;"":jl:m v£ "
,ce
3.
.- ients
IC~l:f' ~l
, .g
~ !
. Te ; uJ Pas;. :md f'7"' .:;, ~1,:
ina Aid Post
.., 'Ji -; l:lqes
B. Inr:_ -~, ! '-
FE
J 2.
t tt'1,
~
'1 t. i.U'3
To t-
-'2'
part' tior:
":1
:me
1. FH> 1'1£0 2. PH: Project Officer Ai Office and staff
Drugs from FH> Hie audio visual aid for VDC Organization
all 1age,
~ I
PrQ'lJl::~P.
-I,
!.jat("
"'1l ::: t cal sunpliE.':, To p 'i&,;: ;~C prl:,~
4.
Prr'-~
DC I, •
"7t
11'\']
t,
0",,' 1 'mtlJni ty in ',neral ohool
ion 1. \/DC Hass Media Face to face con2. Community and 3. APe and PHD Staf tact 4. others - Information
-----t---.----Lack of ur:~~e"lT" "
Tat..!,,::: 17
10 v.ill-cJ?s. 'JY"~S '; . ~ 1
1. APe to keep records on drugs and suppUes 2. VDC should hel p APO transport drugs and supplies from HI hoapital to Aid Post. Invite Hlstarf give talk Use ~etirg as seminar or c ampaign time.
... ... "I
I
To
"'~nn
st andi rYJ ,-,,' cause C,'f ness 1.:.
J.-
,
f'uSlt'
ijT'L 1"'"
(Sup erst it i or' for DisE,"ses) I' Table 12
I
prove he2,lt" knOlL; ~eaJe.
?
1. Health Education 2. Seminar CdIDpaign
-NBC - Church
•
•
•
nME TA8l£\·[Jl ~DlNA PIC PRo.::ECT ACTIVInES, 1961 1980 (HEALTH DEVELOPMENT ASPIlCT)
Annex 4C
ACnVlnES/MIlIITH 1. Actll11t1es for major medical pl'Oblana 1) Health Education 2) Village seminar on Health problems
NIJII.
DEC.
.)\N.
fEB.
MAR.
APR.
~V
~E
.:u.V
ALG.
SEPT.
OCT.
NOV.
DEC.
) )
-- - ---
--- --
3) Treatment/clinic at villages ) 4) Dental Health Campaign
Vlll!!je !reiiInar H. Educ Treatment Dental Skin/ Survey Eyes
-- ---
---
-- - --
TreatDEnt ~icl
41'
Skin/ Eyes
2; Aid Aoat Activities 1) on the job-training
-- -
- --
- - - - --
--
nentar Survey
f.P. Clinic
- - - - --
f.P. Cli- H. nic Educ. 'Filrduc. on cause Df'.
f.P. runic 'It'Tciic
:J:
0 ,..
.... 0
2) a monthly inventory on A.P. II4lPl1ea 3) Regular visit by PHD 3. V.D.C. Organization
-- - - - -- - - - -PHEO
- --
-- - - - -- - - - -- - - visit VOC PHEO
illneas
%>
... ... '"
< t
visit \/DC
t ,., c: ::D
,gm. 5 vllleges 4. Health Education on Causes of illness I:f2a:
.!!!lI..:. 5 villages
~
Review org.
GJ G!
~ ~ ~ ~
.~
I~ ,...
I:IiEI:: ~
r
. TIME TABLE FOR MADlNA PH: PRD.ECT ACTIVITIES, 1981
,
Ann"", 4C ACTlVITlES/MlWTH 5. F111111 Y Planning 1) Health Education 2) FP clinic at village by He or CH sisters/PH> It::H 3) ReaJrd keeping at A.P. 4) 3 monthl Y report by sisters 6. Child Health 1) Health Education an infant feeding 2) Cooking demonstration on infant feeding
1900
NOV. ) ) ) )
DEC.
.)IN.
fEB.
MAR.
APR.
I'AV
:DIE
.1.l.V
ALB
SEPT •
OCT.
NOV.
oa: .
- --
---
(-1
-- - ---
t--\
--- --Village 5eld.nar
+-t
- -- - - -
~
)
ill E
1 :I:
;;; .f---'t CookI;{
.!!S.
:8
- --
---
- -- - - - - --
---
Nutr1-
DIn:Ina-
tion
trstion for infant I feeding
I &! Sprav-
!3
,... 0
0
...
~
'"
7. 1) 2) 3) 4) 5)
Malaria Control Health Education Spray I1aas Drug Ado. Conrunlty Participation Seminar on Role of VDC/ leaders
l'MIT-
Health Educ. Spray I'I3S9
" ... Ul
r
Spray-
nary urvey
Drug Alin.
.!!!L Mass Drug
.!.':!l.
Ado.
Mass Drug Ado.
6. PH: Project Workshop
VUlages
vil-
~ days - - - - ---
~ days
lages
,
•
- 117 -
ANNEX 5 •
KAVIENG GENERAL HOSPITAL - STATEMENT OF POLICY WITH REGARD TO PR~Y HEALTH CARE IN NEW IRELAND PROVINCE - 14 MARCH 1981
In February 1980, the hospital participated in a Provincial Workshop on the subject of pri~~ry health care (PUC). At a meeting held today, representatives of the hospital staff reaffirmed their (a) (b) (c) Acceptance of the principles of PUC. Belief that the hospital has a vital role to play in PUC. Commitment towards the establishment of effective PUC in New Ireland.
Briefly, the role of the hospital in the context of PUC is seen to be as follows (as discussed at PUC Workshop): 1. 2. 3. Relieving Aid Posts and Health Centres of much of the burden of expensive, labour-intensive, curative medicine. Providing technical assistance to Aid Posts and Health Centres with re~ard to medical matters. Acting as a trainin~ ground for all levels of health workers, by virtue of a high concentration of trained staff for teaching and a wide selection of clinical material. Acting as a 'learning situation' for out-and-in patients to help understanding of the nature of disease and the ways that disease may be prevented . Carrying out of research into appropriate ways of dealing with health problems in the Province, and the transmission of information gleaned from such research to those concerned at first-level health care.
4. •
5.
It was felt that the problems involved in regard to hospital function in the above way could be summarized in terms of attitudes: i. Attitudes of staff - elitist; overconcern with the traditional paraphernalia of clinical medicine; "no time for se'cond-rate health care." Attitudes of community towards hospital - limited concept of hospital function need for 'demystification' of hospital function unaware of their responsibilities toward hospital iii. Attitude of hospital towards community - isolated from community; need for community involvement in hospital work; need for better communication with community
ii.
- 118 -
Annex 5 The meeting therefore agreed in principle to the following ten proposals. to be implemented at the earliest opportunity: 1, Improvement in communication between hospital-aid post and hospitalhealth-centre by improving the system of in-patient discharge summaries (Summaries to be sent by post to both the referring centre and the APO of the area from which the patient comes. Summaries to be written in Tok Pisin). Establishment of a monthly newsletter containing health and general information collected by the staff, for distribution within the hospital and to aid posts and health centres. (Member of staff nominated to collect material. Tok Save to staff about newsletter. Health Education agree to arrange and print it.) Approach various community groups with proposals for voluntary work in hospital, e.g. setting up mobile shop or library for patients (Two members of staff to asseSs feasibility with representatives of community groups). Establishment of 'Lifelines' - a list of personal contacts in various departments such as welfare, Primary Industry, Labour Office, Education, Justice - who would be prepared to see patients with their problems (Two members of staff nominated to compile list and discuss with departments concerned). Inclusion of the giving health talks to patient into the duties of senior nurse aides. (Arrangements made by Matron for this to take place in the evenings). Introduction of seminars at the hospital for health and non-health workers on topics such as Industrial Health. Plantation Health (Three staff members to arrange the first of these, liasing with Health Education and Health Inspection). Replacement of or improvement to health posters around the hospital (Staff member nominated to carry this out, with help from Health Education). Increase in number of evening film shows for patients with items of both health and general interest (Staff member to liase with Health Education and Provincial Nutritionist). "Task F " - groups of hosp~tal . orces staff prepared to go out to a PHC area at weekend occasionally to work at a PHC project. e.g. clearing land, digging ditches. putting up fences. etc. (Three staff members nominated to organize the first of these for next month).
..
2.
3.
4.
5.
6.
7.
8.
9.
10.
Establishment of a committee to monitor hospital policy with regard to PHC and to check that the above and other proposals are carried out {Committee elected}.