REVITALIZING INTEGRATED DEWORMING PROGRAMS INTO ROUTINE IMMUNIZATION IN PAPUA NEW GUINEA: A MIXED METHOD IMPLEMENTATION RESEARCH THESIS

Wilson Sali Karoke, Profesor Dr Supargiyono, Dr Retna Siwi Padmawati

2017 | Tesis | S2 Ilmu Kesehatan Masyarakat

ABSTRACT Background: Although the concept of integrating underutilized and underfunded programs into a mainstream health program has increasingly been advocated to remedy the marginalized health sector in Papua New Guinea (PNG), the adverse impacts from the 3 endemic, neglected tropical diseases (NTD) continue to escalate. Soil-transmitted helminths (STH) are the commonest and its nutritional deficiencies are manifested at an unprecedented rate of Stunting (48%), Vitamin A deficiency (27%) and Anemia (48%) in children 659 months. These micronutrient deficiencies have exceeded the public health significance level placing PNG as the country with the highest number of cases for STH in Oceania and one of the 10 global hotspot countries for NTD. A study was undertaken to diversify and innovatively integrated deworming with routine immunization. Methods: A mixed method implementation research using the convergent design was undertaken in Eastern highlands province of PNG, It included 44 participants: 25 general healthcare workers in 5 health centers, 12 health care program managers from 4 district health office and one provincial health office, and 7 healthcare program advisors from the National Department of Health. The study was conducted from March 2017-May 2017. Results: Of the 25 general health care workers evaluated, 88% reported deworming is practically feasible to integrate into the routine immunization programs. Similarly, of the 12 healthcare program managers, approximately 92% reported they will increase the immunization budget when deworming is integrated into routine immunization. The general perception of the health program advisors was that integration was ideal for the contextual settings of the PNG health system Conclusions: The study revealed there were some instances of unprogrammed and interrupted integrated deworming implemented at all of the health facilities. The findings show that there is an overwhelming need for revitalizing the current practice of deworming and institutionalizing a routine immunization program through an integrated approach.

ABSTRACT Background: Although the concept of integrating underutilized and underfunded programs into a mainstream health program has increasingly been advocated to remedy the marginalized health sector in Papua New Guinea (PNG), the adverse impacts from the 3 endemic, neglected tropical diseases (NTD) continue to escalate. Soil-transmitted helminths (STH) are the commonest and its nutritional deficiencies are manifested at an unprecedented rate of Stunting (48%), Vitamin A deficiency (27%) and Anemia (48%) in children 659 months. These micronutrient deficiencies have exceeded the public health significance level placing PNG as the country with the highest number of cases for STH in Oceania and one of the 10 global hotspot countries for NTD. A study was undertaken to diversify and innovatively integrated deworming with routine immunization. Methods: A mixed method implementation research using the convergent design was undertaken in Eastern highlands province of PNG, It included 44 participants: 25 general healthcare workers in 5 health centers, 12 health care program managers from 4 district health office and one provincial health office, and 7 healthcare program advisors from the National Department of Health. The study was conducted from March 2017-May 2017. Results: Of the 25 general health care workers evaluated, 88% reported deworming is practically feasible to integrate into the routine immunization programs. Similarly, of the 12 healthcare program managers, approximately 92% reported they will increase the immunization budget when deworming is integrated into routine immunization. The general perception of the health program advisors was that integration was ideal for the contextual settings of the PNG health system Conclusions: The study revealed there were some instances of unprogrammed and interrupted integrated deworming implemented at all of the health facilities. The findings show that there is an overwhelming need for revitalizing the current practice of deworming and institutionalizing a routine immunization program through an integrated approach.

Kata Kunci : Deworming, integration, mainstream health program, feasibility, PNG