Australian Doctor’s International: Enhancing Rural Health Through Local Empowerment
Overview
Australian Doctors International (ADI) is an Australian NGO registered with the Australian Charities and Not-for-profits Commission. It is a member of the Australian Council for International Development (ACFID) and is supported by the Australian Government through the Australian NGO Cooperation Program (ANCP). ADI is governed by a Board and a suite of governance committees (Risk and Compliance, Finance and Audit, Revenue, Program), with these roles filled on a volunteer basis.
Strategy Infographic
Case Study: Family Planning, Sexual and Reproductive Health Education to Youth in Rural New Ireland
General knowledge on sexual and reproductive health is in high demand in New Ireland’s rural youth population. Due to traditional and religious beliefs, varying literacy levels and reluctance of some rural health workers in delivering in-depth knowledge about this subject, many do not understand family planning in relation to their sexual and reproductive health. As a result, unintended pregnancies and teenage pregnancies are very common in rural areas that ADI visits.
Challenges Faced by Youth
ADI Health Extension Officer (HEO), Mary Silakau, notes that while young people are curious about the topic, they are reluctant to come forward and seek this knowledge. Mary believes that having young people understand their sexual and reproductive health will lead to better understanding and decisions in family planning. Since making this observation, ADI’s patrol team in New Ireland have made a concerted effort to address this gap in knowledge in the youth population. Mary is now looking for other opportunities to increase the understanding of young people on sexual and reproductive health.
Outreach and Education
On outreach, ADI’s patrol team in New Ireland work with students at both primary and high school levels to deliver public health education. Mary has observed that youths are more engaged, opened up more and asked questions when in groups split by gender, so they could ask questions without being embarrassed or ashamed.
Educational Materials and Visual Aids
ADI is working with its clinical staff to produce educational material and visual aids to assist in the delivery of these sessions on sexual and reproductive health and family planning. In doing so, ADI is assisting many young people in rural New Ireland to make informed decisions regarding their health.
In-service Training in Jadelle Implant Insertion
In March 2021, ADI conducted an in-depth training session to four rural health workers in family planning, and Jadelle implant insertion/removals. Training was delivered at Kimadan Health Centre, a large rural health facility serving over 10,000 people in the Namatanai District. This training was delivered by Nursing Officer, Athaliah Bagoi and co-facilitated by Kimadan HC’s Sister in Charge (SIC), Susan Salot. Having previously attended this training in March 2020 and completed the “training of trainers” workshop held by Family Planning NSW, Susan has been accredited as an ADI family planning trainer.
Theoretical and Practical Sessions
Health workers spent two days on theoretical sessions focused on general revision of family planning contraception and counselling. Three days were then dedicated to supervised practical sessions in implants with both insertions and removals taking place at Kimadan Health Centre and Bol Health Centre. In total, 32 clients participated, of which 29 received implants.
Learning Outcomes
Learning outcomes of this training included:
Increasing knowledge on all forms of contraceptive options available in their province.
Identifying and knowing how to effectively dispel common myths and misinformation that may influence requests for inappropriate implant removal.
Conducting effective client consultation and counselling, including post-partum insertion.
Demonstrating safe and effective Jadelle implant insertion and removal, and managing difficult removals and correctly using aseptic technique.
Competency Assessment
All participants were supervised by trainers and assessed on their skills in Jadelle implant insertions and removals to determine their competency. Additionally, at the conclusion of training all participants stated that they felt "very confident" in Jadelle insertions, and 90% of participants reported the same for removals. All health workers also reported that after the training, they felt better equipped to counsel women on both the advantages and disadvantages of Jadelle implants.
Future Training Plans
Another round of this training is currently being planned for later this year to a fourth cohort of health workers in New Ireland and for the first time, in West New Britain. Currently, ADI is also working with PNG staff and health workers to improve training content to ensure it is more culturally relevant and aligns with the needs of rural health workers. This is the second in-service training in family planning ADI has facilitated that has been led entirely by PNG health workers.
Localisation and Training Capability
While COVID-19 has restricted travel from Australia, it has provided an opportunity to acknowledge the value and importance of localisation, and prioritising the PNG health workforce with skills to train their fellow colleagues. ADI has focused on building the competence of trainers to nurture and increase in-country training capability. Future family planning trainings will also be delivered by PNG staff, with Sydney staff closely monitoring and providing support and logistical assistance.
Challenges Faced in FY20/21 and Upcoming Activities for FY21/22
Impact of COVID-19
Since 2020, the impact of COVID-19 has affected all aspects of ADI’s activities in PNG. While we have been able to adapt certain activities to work within national and provincial restrictions and recommendations to continue the delivery of training and clinical services, we have experienced delays at the request of our in-country partners. In March 2021, as PNG saw a surge in positive COVID-19 cases, family planning training in West New Britain was postponed to assist with the province’s need to reallocate staff and resources.
Supply Chain Challenges
ADI has also been notified that due to national funds being diverted towards PNG’s national COVID-19 response, supplies of family planning commodities have been delayed for 2021, and there is currently a nationwide shortage of contraceptives in rural areas. ADI continues to advocate for continuity of commodity supplies. As well as this, ADI has also observed that other related commodities such as local anaesthetic (lignocaine) and sterile equipment required for some family planning procedures, is also in short supply. ADI has been able to supplement patrol staff with these items (including the provision of a portable autoclave to sterilise equipment in rural areas which is necessary to offer contraceptive options such as implants and IUDs), however, rural health facilities continue to face difficulties in procuring these items through the national system.
Advocacy and Collaboration
ADI is regularly invited to PNG’s national sub-cluster meetings with other key stakeholders, to discuss family planning issues in the country and will continue to advocate for the inclusion of rural health workers and health facilities in national family planning strategies and plans.
Upcoming Plans
In the coming year, ADI looks forward to continuing our work in family planning with your support. Plans for in-service training to rural health workers in New Ireland and West New Britain, are well underway for November 2021.
The emphasis on community education of family planning, gender equity and reproductive rights will continue in 2020/21 to address the various myths, misconceptions and poor practices in villages. By working with community members at various levels, we plan to inform both men and women of the importance of gender equality, family planning and ensuring women are given access to appropriate information and services regarding their sexual and reproductive health in an environment conducive to that decision making.
The inclusion of a family planning officer and gender equity officer will continue to be a priority on our outreach health patrols as they visit remote and rural communities in both New Ireland and West New Britain. For many isolated women, this is one of the few opportunities available for them to access family planning information and services.
Key Activities
Training and Clinical Services
ADI has maintained the delivery of training, clinical services and community education in family planning in rural communities, while also managing and supporting PNG's COVID-19 responses.
COVID-19 Response
In March 2021, PNG saw a surge in positive COVID-19 cases nationwide, limiting the delivery of some of our activities as originally planned. However, this has also provided opportunities for ADI to direct its focus on investing in PNG’s health workforce further and emphasise the importance of localisation. ADI now has PNG staff dedicated to family planning, maternal health and gender equity in all three provinces where we work – New Ireland, West New Britain and beginning in late 2020, Western Province. With the growing number of staff, ADI has been able to expand our reach in rural areas. ADI remains committed to a multi-pronged approach to improving women’s health and wellbeing, with family planning central across all of our activities.
Vaccine Advocacy
Currently, ADI is advocating for PNG’s provinces to receive regular and sufficient supplies of COVID-19 vaccinations, and will be assisting with the distribution of these vaccines to ensure rural health workers are well-protected and supported, to continue the provision of essential health services in their communities, including in family planning.
Highlights from ADI's Family Planning Work (2020-21 Financial Year)
Family planning services and awareness delivered on 21 outreach health patrols across three provinces, delivering 90 hours of public health education on family planning and sexual reproductive health to 12,000 rural community members.
In-service training focused on Jadelle implant insertion to rural health workers in New Ireland.
Contributions towards 1680 couple years protection (CYP) through the provision of contraceptive services.
Expanding family planning work in Western Province - increasing availability of contraceptive counselling and services to rural women in the province's North Fly District. ADI will also be delivering training in this province.
Gender Equity program established in all three provinces.
Outreach Health Patrols
Providing family planning services and reproductive health education for rural health workers and community members is one of ADI’s core activities. ADI undertakes regular, outreach health patrols in partnership with local health authorities and health providers. During these patrols, activities include providing contraceptive methods alongside counselling, training local health workers, community awareness and distribution of family planning commodities.
During the 20/21 financial year, health professionals and educators providing family planning services and education attended 21 outreach health patrols in all three provinces where ADI is located. In total, patrols visited 60 rural health facilities and 80 communities and villages across three provinces – New Ireland, West New Britain and Western Province.
During these patrols, women and couples received a range of family planning services including contraceptive services and counselling.
Community Education
In addition, community education sessions to increase awareness and understanding of family planning were also delivered to rural communities. Education sessions are tailored to address key barriers and misunderstandings communities may face, that impact access and acceptance of family planning for rural women. Common issues that are often addressed during these community education sessions include:
Understanding birth spacing and its impact on maternal health
Knowing what contraceptive options are available for rural women in PNG, and dispelling rumours and misunderstandings they may have in regards to contraception (e.g. implants can cause cancer, side effects often misunderstood as sickness caused by contraception, etc.)
Community-wide understanding of reproductive rights, and what it means for women to make their own decisions regarding their health.
In this financial year, approximately 90 hours of education on family planning and sexual and reproductive health were delivered to over 12,000 individuals in rural communities visited on patrol. In addition to this, ADI's Gender Equity Officers also delivered awareness sessions on gender equity. Outreach health patrols also provide opportunities to engage with local health workers, and provide support and training based on their needs and requests. Many rural health workers in PNG work in isolation, with little opportunities for professional development.
Supporting Remote Health Workers
A volunteer Doctor, Nursing Officer, Health Extension Officer (HEO) work alongside these local health workers during patrols, offering guidance and support in carrying out family planning services, counselling, implant insertions and removals. This year, 19 rural health workers received clinical, case-based training in family planning during ADI patrols in the health facilities where they worked.
Supporting remote health workers at the place they work is important for consolidation of skills, further training in counselling techniques and practical contraceptive revision. Case-based training reinforces learnings from in-service trainings, and gives health workers the opportunity to practice their history taking and decision-making process, ask questions and get tailored input into their practice. This annual follow-up is an integral part of ADI’s capacity building approach.
Expansion in Western Province
In July 2020, ADI also expanded our family planning work in Western Province with the commencement of new staff member, Ruth Biendwore. With over 25 years of clinical experience working for organisations including Catholic Health Services, North Fly Health Services, World Vision, Marie Stopes PNG and Port Moresby General Hospital, Ruth’s input in strengthening ADI’s family planning work has already been invaluable. While ADI has been established in Western Province for more than 20 years, this is the first time ADI has had a permanent, PNG clinician dedicated towards providing family planning and maternal health services to rural women in the province. Ruth has strong leadership skills and has fitted into the team very well. She has a passion for promoting women's rights to have information and choice to determine their contraception options.
Provision of Contraceptives and Contribution to Couple Years Protection (CYP)
Couple years protection (CYP) refers to the estimated protection provided by contraceptive methods during a one-year period. In the 20/21 financial year, ADI’s outreach health patrols and in-service training contributed towards 1610 CYP.
ADI’s partnership with UNFPA PNG established in May 2020, has allowed for sufficient supply of family planning commodities during this financial year, that has contributed towards the CYP achieved. When possible, ADI has distributed supplies of implants to rural health facilities where there is a family planning-trained health worker. Due to COVID-19 however, consistent and regular supplies of commodities via UNFPA PNG has not been guaranteed for 2021 due to worldwide delays in shipments, as well as the reallocation of funds by the PNG National Department of Health (NDoH). ADI is closely following this situation, as well as exploring all options for continuity of supply.
Gender Equity Program
Gender Equity Officers continue to participate on all outreach patrols. In this financial year, we have expanded our Gender Equity program with dedicated officers delivering education in this area in all three provinces. Improving gender equity is integral to increasing access to appropriate contraception options for women. In addition to patrols in rural areas, ADI’s Gender Equity Officers have also been approached by schools and organisations in urban areas, to deliver awareness to students.
Over 50 hours of education on gender equity, including discussions on reproductive rights, adolescent pregnancy, PNG laws and referral pathways for survivors of gender-based violence and sexual violence have been delivered this financial year. In addition to gender equity education carried out on patrol, ADI has also concluded its Community Mobilisation Training (CMT) program in New Ireland. The CMT program was aimed towards community leaders and key decision makers to initiate and maintain community-wide change on gender issues, women’s involvement and gender equality during a three-day workshop.
Since the start of the CMT workshops in August 2019, ADI has delivered training to 11 different wards in the Namatanai District, training a total of 302 community leaders. Due to the relocation of the facilitator back to her home province in the Highlands, the CMT program in New Ireland is currently on hold. Meanwhile, ADI has been working with Gender Equity Officers in West New Britain and Western Province to also assess the information and support needs of community leaders so they can be part of positive improvements in gender equity and women's health.
Make a donation.
A small act of kindness can ripple into a lifetime of change. Help us provide vital education and health outcomes, paving the way for a brighter tomorrow for girls and women.