Challanges With the Immunization Program in a Remote Area in Papua New Guinea
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Abstract This thesis uses the framework for rural and remote health (Bourke et al., 2012) to analyze the child immunization program in a rural remote part of Papua New Guinea. This is done using an analogic approach supplemented with available literature on a global, national, and local level. The Schouten Island is a small island group located at the shore of the East Sepik Province in Papua New Guinea (PNG). Coverage of basic vaccines in the routine immunization program is low in PNG in general, but particularly low in this province. PNG has a diverse topography with a wealth of different cultures in their many rural and remote communities. 87 % of the population lives in rural areas, and there are over 800 languages spoken. Based on experience from working with the Youths With a Mission (YWAM) Medical Ship in remote parts of PNG, I wanted to investigate the immunization program performance in this kind of environment. There are many studies on isolated problems related to the health service delivery in remote areas, but little is viewed from a community-based perspective. The framework for rural and remote health provides a holistic and people-centered approach to discuss this specific health outcome in a remote community. There are several interrelated aspects resulting in the outcome of the immunization program in this remote setting. Low availability of health workers and closure of many health facilities in the district has made the accessibility of the service difficult. There is low evidence of cooperation and communications with the local rural and remote communities in the literature. In addition, communication systems between local health facilities and health authorities at district-, provincial-, and national level is fragile. Strategies for a holistic people- and community centered approach is implemented in the national policies, but seems to be difficult to implement at the local community level.