Appendix 4: Performance and trends

Appendix 4: Performance and trends

Once the data is more complete ARB DoH should consider why these patterns are evident and what practical steps can be taken to improve performance in poorer performing facilities. In many instances the knowledge on how to improve performance already exists within ARB. Looking at practices where performance on a particular indicator is high can reveal practices that might result in better performance if adopted in other health facilities. There needs to be a good match between strategies outlined in the Bougainville Health Plan and activities that will improve performance against these indicators.

Outpatient visits in ARB are low at an average of 0.9 visits per person per year in 2011. The rate has been fairly constant over recent years. Many factors affect outpatient visits and it is difficult to determine why the rate in ARB is low compared with the PNG average. The rate may reflect factors such as accessibility, perceived range and quality of services offered and/or preventive measures being taken at the individual or community level. Sipai and Tonu HSCs both have high outpatient visit rates, exceeding the PNG average.

ARB performs better than PNG as a whole. But the percentage of Bougainville children aged less than 5 years who attend MCH clinics and weigh less than 80% of the expected weight for their age has been increasing since 2008. This is most notable in the North Region around Buka. In the south, the rate decreased from 2009 to 2010. The best-performing health facilities were Boku (0%) in the south and Gagan (2.4%) in the north. The indicator may reflect food availability and climate conditions as well as health and hygiene practices in the community.

For both measles and pentavalent coverage, Bougainville is performing better than PNG. Rates generally decreased from 2006 to 2009 but have since begun to improve, particularly between 2010 and 2011. Improvements have been most evident in the North and South with virtually no change in Central Region. Bougainville’s coverage was higher than the PNG average in 2010 but well short of the 2015 targets.

Bougainville performed better than PNG as a whole on both supervised deliveries and antenatal coverage in 2010. Rates for both these indicators, however, have dropped since 2007 except in the North Region where antenatal coverage increased considerably from 2010 to 2011. The main contributor to high rates of antenatal coverage in the north is Buka Urban Clinic with a rate close to 300%. This rate suggests that people from other areas attend this facility and/or denominator figures are incorrect. Sipai Health Subcentre, Tearouki and Buin Health Centres all achieved over 100% antenatal coverage in 2011.

The decline in supervised deliveries has been most serious in Central Region. Buka Hospital is not reflected in the data above but provides over one quarter of all supervised deliveries. All three regions are achieving less than the Maternal Health Taskforce recommended 80% supervised deliveries but several individual facilities are close to the recommendation. Tearouki Health Centre and Monoitu Health Subcentre exceeded 100% of supervised deliveries. ARB has some way to go in order to achieve its 2015 targets for both these indicators and the key may be with these high-performing facilities.
Health sector strategy 5: Improve maternal health

Objective: Increase family planning coverage
Indicator: Couple years protection per 1000 women aged 15-44 years
ARB 20101	74
Best ARB Region 2010	149	Buka – North Region
Best ARB Health Facility 20112	780	Buka Urban Clinic
Worst ARB Region 2010	15	Buin – South Region
Worst ARB Health Facility 2011	1	Katuhkuh Health Centre
PNG 2010	74
PNG Target 20153	115
ARB Target 2015	115

Sources:

¹ ARB 2010 data from ‘Annual Sector Review North Solomons Province District Performance 2006-2010’

² ARB 2011 data from ‘North Solomons Province Family Planning (YTD) Report Jan to Dec 2011’ printed 4/3/12

³ PNG MTDP 2011-2015

In 2010 ARB performed at the same level as PNG for contraceptive prevalence coverage. However, there is huge disparity between the North and the other two regions. There was a sudden increase in use of modern contraceptives in the North Region in 2009 and again in 2011. This has been attributed to the work of a female obstetrician who was based at Buka Hospital from 2008 to 2011. Although awareness training was conducted in many parts of Bougainville there has been very little change in the indicator in the Central and South Regions from 2006 to 2010 and just a slight increase in 2011. Rates are well below the PNG average in Central and South Regions and work will have to be focused in these areas in order to reach the 2015 target.

Malaria has declined on Bougainville since 2006 although less so in the north than the other two regions. LLIN were distributed from 2006 and may have contributed to the reduction in malaria cases. The incidence of malaria in Bougainville is less than in PNG as a whole. However, the Bougainville Health Plan sets ambitious longer term goals. A broader range of strategies implemented in all regions may be needed to achieve these targets.

After slowly but steadily declining from 2006 to 2009 there was a sharp increase in diarrhoeal diseases in Bougainville in 2010, as was the case nationally. The increase was more pronounced in the North Region. Despite this increase, Bougainville continued to have less diarrhoeal disease than PNG. Water and sanitation will need to improve in all areas if the 2015 target is to be met. Hygiene may also need to improve.

Rates of injury in Bougainville are considerably lower than the national average in all regions and have decreased between 2006 and 2010. Nonetheless, admission for the treatment of injuries ranks third overall in the ARB morbidity profile in 2010.