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Originally produced for UNICEF

The children

Hundreds of thousands of children in Papua New Guinea live in conditions similar to those in Atemble. Their villages lie alongside rivers, or in the highlands of the interior or on the hundreds of islands that surround the “mainland.” Their exclusion from health, education and other basic services is reflected in considerable disparities in virtually all indicators of child survival and development. There has been no apparent change in these indicators over the last twenty or thirty years.

Based on an average national poverty line of 461 Kina ($136) per adult, about 37 percent of PNG’s population must be considered as poor. The vast majority (93%) of the poor live in rural areas, where over 41% of the population fall below the poverty line. Many of the poor have no cash income and thus derive their livelihoods almost entirely from subsistence agriculture. Of those who earn cash income, poverty is highest among those engaged in small-scale tree crop production, domestic agriculture and hunting - gathering. Over 40% of all households in Papua New Guinea derive their main income of export tree crops. Poverty is significantly more widespread among households whose head has not attended school.

The national infant mortality rate is 77 per 1000 live births, one of the highest in the Pacific region. In urban areas the rate is 33 per 1000 live births, compared with about 114 per 1000 in the highlands. Overall, about 100 out of every 1000 children die before reaching their fifth birthday, but a child living in the highlands is three times more likely to die before age five than a child living in urban areas.

The primary causes of child death are pneumonia (33%), neonatal infection (17%), slow foetal growth/immaturity (11%), hypoxia /asphyxia (17%) and meningitis (7%). Pneumonia and malaria are prominent causes of death among older children. All causes are exacerbated by poor nutritional status among children, almost 30 per cent of whom are underweight. Regional disparities in malnutrition show that about 12 per cent of children living in the national capital district of Port Moresby are underweight, compared with 42 per cent in Madang Province and 45 per cent in Milne Bay Province.

Poor nutrition is the result of the late introduction of complementary food, the high rate of infections and diseases, especially malaria, and the poor quality of the food children consume. This is partly the result of food taboos. Many people believe that fish, meat, eggs, fruit and some vegetables are damaging to pregnant women and young children. Infrequent feeding is another major cause. Children are often unfed when they accompany their mothers to work in the family gardening plot.

Inequalities are evident in per capita health expenditures, estimated at 46 kina (about US$15) per capita in the capital, 32 kina (about US$11) per capita in Milne Bay and just 15 kina (about US$5) per capita in Madang. Another indicator of unequal access to health care is the maternal mortality rate, estimated at 375 per 100,000 live births nationally, but at 625 per 100,000 in the highlands. Nearly twice as many women in urban centres (87.4%) as in rural areas (42.9%) use a health facility to deliver their baby. Yet poor access to health services is only partly responsible. Traditionally, many highlands women wander off into the bush when their time comes, to deliver their babies by themselves. Approximately 40 per cent of all pregnant women are anaemic, but in some pockets it could be as high as 80 per cent. Anaemia was among the top ten causes of hospital admissions and deaths among children between 1990 and 1995.

About half the children in Papua New Guinea never enroll in primary school. In the next few years more than 14,000 elementary classes offering preparatory level and Grades 1 and 2 will be established in villages. In most cases, the teacher will be a young Grade 10 graduate from the community who volunteers for training. The preparatory, first and second grade classes will be taught in the vernacular which is an advantage for village children who do not speak English. Over the next couple of years many more children will matriculate but the potential for the current generation of poor rural children to obtain more than a limited basic education remains remote. About half the adult population is illiterate. The challenges for village development for the next several years therefore include working with a predominantly illiterate adult population.

People-Centred Planning

The exclusion of rural children from health, education and other basic services is partly the result of geography, of difficult terrain, stormy seas and the high costs of transportation, but this is probably not the primary cause. Since gaining independence from Australia in 1975, Papua New Guinea has been beset by political turmoil and economic crises. Governments have been vulnerable to the shifting tides of political re-alignment. Frequent votes of no-confidence undermine and often bring down the group in power. The economy, based on globally significant reserves of gold, gas and other resources, is vulnerable to fluctuations in market prices. More significantly, poor governance has meant that periods of economic growth have not translated into increased opportunities for people. Until recently, the health and development of the rural poor, especially children, was not a government priority.

In the early 1990s, the Bougainville crisis forced the closure of the rich Panguna mine. Drastic budget cuts followed that severely undermined the health system. Recovery began in 1995 with the introduction of the Organic Law, which committed all levels of government to people-centered development focusing on health, education, rural infrastructure and primary production. Progress was slow at first but by 2000, about 60 per cent of the wards had Aid Posts that were either staffed by minimally trained Aid Post Orderlies who usually had 6th or 7th grade education or by Community Health Workers who were high school graduates who had followed a two year training course. The National Health Plan for 2001-2010 further emphasised the need for more people centred approaches and set many important goals for reducing infant, child and maternal mortality through improvements in immunization, nutrition and treatment of illnesses in children, particularly diarrhea and respiratory diseases.

Yet while the policy frame work for decentralization and “bottom-up” planning had been established, the practical tools to enable the process to go forward were missing. Several consultations were held to try to advance the concept, including a bottom-up planning session held in Esa’ala District, Milne Bay, in August 2000. During the workshop, local leaders were asked to name priorities for their communities and the list that emerged included electricity, roads, bridges and other projects demanding major investment.

Iba Luke, an administrative officer from Duau Local Level Government, was very disappointed in the outcome. “It was hopeless. There was nothing on the list that we could do for ourselves. We were left in exactly the same situation as before, just sitting around waiting for someone to come with the money and the expertise. It made us seem so powerless; as if we were incapable of doing anything for ourselves, when we are not. There is a lot we can do.”

Iba Luke eventually emerged as one of the foremost local advocates of the Community Based Best Practices project which he, and other local leaders, saw as a strategy not only for improving child nutrition, which was its original purpose, but as a foundation for village development.