Improving Midwifery Skills in PNG

Background:

Improvements in midwifery have been ongoing since NDOH Maternal and Child Health Taskforce Report (2009). Over this 10 year period many areas have been worked on and yet many challenges still exist. Following the task force the Maternal and Child Health Initiate (MCHI) was establish and carried out 2011-2015, funded by WHO, DFAT with support from HHISP.

The main aim of the MCHI was to contribute to a decrease in maternal mortality rate in PNG in a sustainable manner through improved quality of essential maternal and newborn health care. Objectives of the Initiative were:

• To improve the standard of midwifery clinical teaching and practice in the five teaching sites
• To improve the quality of obstetrical care in two regions through the provision of clinical mentoring, supervision and teaching

A clear outcome of the MCHI M &E was the need to revise the 12 month midwifery curriculum to an 18 month program. To improve quality of midwifery graduates, to be meet academic (diploma to degree), clinical skills requirements and update midwifery curriculum to 21st century thinking.  This was seen to be important in addressing the challenge below.

MCHI Resource Link:  https://www.uts.edu.au/research-and-teaching/our-research/who-collaborating-centre/terms-reference/4-maternal-and-child-1

Challenges:

• Midwifery entry in PNG is a registered nurses, so the quality of the nurse effects the MCH in PNG
• There is a 28% shortage of nursing and midwifery educators in PNG6,7,11,22  with only 50% holding an education qualification, resulting in low quality graduates. Department of Health, PNG: http://health.gov.pg/
• There are very few opportunities for continuing professional development
• Midwifery is a post registration program so does not attract DHERST student funding
• Whilst Australian Awards funds are essential funds they are not ring fenced and often go to the  university administration, leaving midwifery unit without educators, transport and resources
• Political influence to have a School of Nursing in each province has resulted in a mushrooming of nursing from 8-17 without an increase in educators to run them.
• Increase in numbers of nursing students is now being achieved however the PNG NC has significant concerns about the quality of graduates from outdated and old curriculums (late 1990’s)
• PNG is the only country in Pacific to not have Chief Nursing and Midwifery Officer
• WHO states you need 1 midwife for every 175 births or to cover health outcomes and SDGs 4.5 nurses, midwives and doctors per 1,000 population
• For every 1,000 births as many as 9 mothers and 24 babies die, WHO and PNG Health Minister 2019 meeting estimates 6000 more skilled birth attendants needed to meet the global standard. WHO Media Release: https://www.who.int/papuanewguinea/news/detail/28-02-2019-minister-pledges-to-reduce-high-maternal-and-newborn-mortality

Skills Log Book Workshop:

The 12 month program phased out at the end of 2018. Thus, review of the skills log book is crucial prior to the implementation of the 18 month program. The new knowledge and skills added to the national midwifery curriculum framework are not included in the old skills log books. The PNG nursing Council and NDOH funded by the Australian Awards, held a Midwifery Skills Long Book Workshop at University of Goroka in March 2019. The following workshop objectives were made and accepted;

 

Workshop Objectives:

1. Review current PNG Nursing Council Midwifery Competence and make amendments if required.
2 . Review structure of National Midwifery Curriculum Framework & Implementation Plan (2014) to be able to develop contents of midwifery clinical skills log book.
3. Produce a final draft structure of midwifery clinical skills log book for validation by stakeholders. 

Summary:

Participants agreed it was a good learning experience and extremely helpful to discuss midwifery competences, student attributes, assessments and student issues with educators and clinicians. The new 18 month curriculum covers all new national and international policies and procedures.  It was however, consider quite alarming that over half of important and current skills like accurate use of partograph, up-to-date contraception methods, PPTC, diabetes and nutrition are not currently captured in skills log books.

All Objectives were met in workshop, however time was limited to be able to create the whole new skills log book and review it. Several recommendations and a brief were produced to be approved by PNG Nursing Council Board.