Papua New Guinea Critical Care Capacity Building Project

The PNG Critical Care Capacity Building project aims to increase the critical care capacity of Papua New Guinea’s (PNG) clinicians and thereby decrease the morbidly and mortality of seriously ill and injured children presenting to hospital for treatment and care in Intensive Care Units (ICUs).

With an under-5 population of 1.96 million, PNG’s population is both young and growing.  87 per cent of the population continues to live in rural areas.  With a such a large proportion of the population living in rural areas, providing effective critical care for seriously ill or injured children through a decentralised health system, is a challenge. This challenge is exacerbated by a critical shortage of human resources for health.  Recent estimates of health worker densities reflect 0.5 physicians per 10,000 population.¹

Key statistics on child morbidity and mortality

• In 2019, there were 29,901 admissions and 1923 deaths recorded (mortality rate 6.43 per cent). This is significant improvement in the mortality rate compared with 5-10 years ago.
• In 2019, there were 1244 post-neonatal deaths out of a total of 21,930 patients (CFR 5.7 per cent) and 679 neonatal deaths out of 7971 patients (neonatal CFR 8.52 per cent).
• Pneumonia was the most common reason for admission (4818, 16.1 per cent of admissions), but a lower proportion of all admissions than in previous years. Pneumonia case fatality rates were significantly lower than in previous years: 3.6 per cent overall (previously 5 per cent), and 7.4 per cent for severe pneumonia (previously more than 10 per cent).
• 27 per cent of all admissions were in the neonatal period. Neonatal deaths accounted for just over one third (35.3 per cent) of all childhood deaths. The leading causes in neonates were combinations of neonatal sepsis, birth asphyxia, and very low birth weight.
• Severe malnutrition was present in 2411 admissions (8 per cent of admissions), a reduction on previous years data.  Malnutrition caused or contributed to 250 deaths (13 per cent of all deaths and 20 per cent of post-neonatal deaths). Case fatality rates for severe malnutrition are significantly lower than in previous years; 10.4 per cent in 2019. This is a big improvement on previous years and close to the World Health Organization target of under 10 per cent. Many additional children had moderate malnutrition.
• In 2019, there were almost 1000 children admitted with chronic non-communicable illnesses – asthma, bronchiectasis, rheumatic and congenital heart disease, epilepsy and cerebral palsy, and cancer.  Death rates for some of these conditions are high.  More awareness of how to care for such children in hospitals and in communities is needed.²

• To increase the capacity of PNG clinicians to respond to the early management of acutely ill and injured children in PNG.
• To increase local capacity to independently deliver life support training courses to PNG clinicians.

Some of the key project activities and outputs:

Key activities include a suite of paediatric life support training courses for doctors and nurses over the three-year life of the project to build knowledge and skills.  Courses include:

• The three-day Advanced Paediatric Life Support (APLS), which increases confidence and skills across a range of paediatric emergencies resulting from injury and illness.
• The one-day introductory Paediatric Life Support (PLS) course, which covers the basics of emergency paediatric management, with a particular focus on the first ten minutes of emergency care.  
• The three-day Generic Instructor Course (GIC), which provides participants with the skills and techniques required to function as an accredited APLS instructor.

This project is expected to improve health outcomes for paediatric patients in PNG.

Those that will directly benefit from the program include some 324 doctors and nursing working in ICUs and High Dependency Units (HDUs) and their patients

Those that will indirectly benefit from the Program are an estimated 7,500 children annually.  This figure is based on the 2019 health statistics which saw 7,648 acutely ill and injured paediatric patients admitted to ICU at the Port Moresby General Hospital and the ANGAU Hospital in Lae. 

Supported by:

• The Australian Government through the Australian NGO Cooperation Program (ANCP)
• RACS Foundation for Surgery 

In partnership with: 

• PNG National Department of Health
• Port Moresby General Hospital (PMGH)
• APLS Australia