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Originally produced for UNICEF

Village planning

The Community Based Best Practices for Child Survival and Development programme focused on two provinces that showed the worst nutrition indicators: Madang and Milne Bay. Political upheaval prevented progress for some time, but expansion in the recruitment of community health workers (CHW) in 1999 provided new opportunities. During that year, a manual on child health and nutrition was developed and used in the training of more than 40 CHWs assigned to work in the provinces of Madang and Milne Bay. In July 2000, UNICEF and the Department of Health jointly supported the appointment of an international consultant to be based in the Nutrition Section of DOH, who would oversee the next phase of project development

At the outset it was recognized that an exclusionary approach to health service delivery was a major obstacle to improvements in child health and nutrition. Community members were largely passive recipients of health care and were not normally involved in planning or monitoring processes. The health workers were also passively waiting in health facilities for sick patients to show up. Their role was curative, not preventive. The challenge for the Community-Based Best Practices project was to develop a tool that would help break down the barriers between health services and communities, and empower families to define, prioritise, satisfy and monitor their health needs.

Between July and October 2000, the consultant and members of the Department of Health worked with local leaders and villagers in the districts of Esa’ala in Milne Bay and Middle Ramu in Madang District, developing and testing the “Colour My House” tool. The tool was based on the Triple A process adapted from a scheme previously used by health workers in the Philippines. In Papua New Guinea it was to be family-based, participatory and educational. The tool allowed families to assess their situation against 19 key indicators. Collectively, the coloured houses provided an assessment for the village, and became the basis for the Ward Plan. It defined community-based actions and overall goals that were officially submitted through political bodies and to administrative and health authorities. In this way the village plan became part of district and provincial plans.

An important dimension of the project was the establishment of a community team that included the Ward Member (the local political leader), the Community Health Worker and members of the community who were trained as trainers. They worked together, running the “Colour My House” assessment with all families participating, and guided the community through analysis, project planning and implementation.

As a result of the project, issues related to child health and nutrition began cropping up as political issues at the Ward, Local Level Government and District levels. According to Peter Lavidah, the District Administrator of Middle Ramu, “We never talked about these issues before. Never. We talked about the terrible transport situation, about how we needed roads and bridges. But now I see that we have a real crisis in immunization! In some of our more remote wards, there have been no mobile immunization teams for the last five years! Until we had this process, this simply was not clear to us.”

John Christie, Team Leader with the Health Sector Support Programme of AusAID commented, “this is the first time I have ever heard of villagers in Papua New Guinea actually demanding immunizations and birth certificates to establish the citizenship of their children”

To date, 19 Wards in the two provinces have been trained in the Triple-A process and 9 of these have begun implementing projects based on the outcome of their assessments and analysis. In the coming year it is expected that half the Wards in each province will be trained in the process.

The expansion of the project occurs organically: every time a “Colour My House” activity is carried out, leaders and health workers from neighbouring communities are invited to observe, participate and learn “on the job.” The chief expense involves the provision of basic materials – charts, coloured pens and a sheet with the house template for every family. UNICEF’s role is to provide technical assistance and materials support during the pilot phase.

The project is still in a pilot phase but has already been endorsed by the Department of Health as a strategy that should be adopted by other donor agencies and projects. In April 2001, a process began of expanding the strategy to the six provinces falling under the Health Sector Support Programme backed by AusAID. To date, selected staff from provincial and district-level health and nutrition services have been trained in the process. By the end of the year it is anticipated that at least one district in each of these provinces will be implementing the process and developing district and provincial plans based on the outcome.

Methodology and Constraints on the Case Study

I spent six days in Papua New Guinea in constant company and dialogue with several members of the Department of Health which runs the project, and as well as Provincial and District Officials for Madang, Middle Ramu and Esa’ala. These included Clementine Yaman, Markus Kachau, Jennifer Simon, Peter Gaan, Paul Mabong, Gei Raga, Peter Lavidah and Henry Briones, a consultant and technical advisor with the Department of Health who is partially funded by UNICEF. Visits to the villages of Atemble and Tsungribu included observation of the “Colour My House” process and provided opportunities for on-the-spot interviews with villagers, local leaders, health workers, district and provincial officials. There was insufficient time to visit Esa’ala District. However, more than twenty health workers, ward members, ward recorders, local level government representatives and the district administrator travelled from Esa’ala to Madang for a one day experience-sharing conference with their counterparts in Middle Ramu District. This valuable exchange was specifically arranged for the case study although it would have happened anyway eventually. Extensive interviews were conducted with Henry Briones, UNICEF Representative Richard Prado and many members of the Department of Health, including the Director of the Health Improvement Branch, Enoch Posanai. Documents related to the project were obtained from the Department of Health and UNICEF.

The chief constraint on the case study is the brevity of the project. The “Colour My House” process was tested in Begasi and Weyoko Wards in Esa’ala District, in October 2000, and in Atemble Ward in November. Only one Ward, Atemble, had completed a quarterly evaluation of progress. Yet the scheme was expanding rapidly and had gained its own momentum. Ward members who had not participated in the activities yet were asking to get it into their wards. District officials and the Department of Health laid strong and justified claims of ownership.