Papua New Guinea

Long journeys but rising immunization rates in Bougainville

Strapping her 3-month-old child to her bosom, Miriam Oriwi prepared for the journey needed to properly immunize the baby – this time for the third round of diphtheria, tetanus and pertussis shots. To reach the nearest health centre, they’ll ride 90 minutes in a public transport truck and then walk an hour. If all goes well, they’ll return by nightfall. Or they could be stranded, a huge nuisance on top of the costly transport fees.

It is the rugged reality of villagers the region over who live in areas too remote for basic health service. But the situation used to be much worse in the Autonomous Region of Bougainville, Papua New Guinea, where 34-year-old Oriwi lives with her husband and seven children. With an estimated population of 175,169 people, Bougainville is one of the poorest and most deprived areas of the country.

Health services were severely disrupted during the ten-year conflict that ended in 1998. Many of the original 149 health facilities were left destroyed and many health workers displaced. Because of the conflict, Oriwi’s two eldest children never received any of their early immunizations.

But Bougainville has barely recovered. Currently, only 29 health centres and three hospitals are functioning on the island, albeit with meagre facilities.

Many communities further inland and on outlying smaller islands and atolls have no access to health facilities. Shortages of essential drugs and the high cost of medicines, lack of or the poor condition of health facilities, high hospital fees, the scarcity of qualified health workers and the lack of emergency transport remain challenging issues in Bougainville.

UNICEF has been helping to improve immunization programmes in remote areas such as Bougainville as well as throughout the region. In Bougainville, the assistance has helped to strengthen cold-chain facilities, including the provision of generators to health centres. UNICEF also has funded social-mobilizing initiatives to promote increased immunization coverage.

In addition, the UNICEF assistance has helped to improve micro-planning for immunization, supervisory visits, support to outreach immunization programmes and supplementary immunization activities, such as a health week campaign in August 2008.

Oriwi hopes that one day health services will be closer to her village, to avoid the high transport fares. The round-trip journey to the health facility in Arawa costs 12 kina (US$5). “Sometimes it is very hard to find available transport,” she said. “Some vehicles return early or even very late, which requires us to seek accommodation with relatives living in Arawa.”

Although it may be a while before a facility springs up in Oriwi’s neighbourhood, improved access may find its way to her and her children. Since 2006, a team of health workers have been trekking the remote areas of Kieta district to stay true to the promises of immunization access.

“Most villages are located in rugged terrain so we travel to the areas by foot,” explained Noelyn Kutono, a registered nurse at the Arawa Health Centre. The arduous effort is made more difficult by the shortage of nurses, she added.