Burnet Institute’s collaborative research approach is a powerful means to promote evidence-based public health policies and as a tool for real and sustainable change.
The UN Global Strategy for Women’s and Children’s Health for 2010-2015 provided a roadmap towards the achievement of Millennium Development Goals (MDGs) 4 (reduce child mortality), 5 (improve maternal health) and 6 (combat HIV/AIDS, malaria and other diseases). It promoted a strategy to enhance funding, strengthen policy and improve health services for the most vulnerable, with the aim of saving 16 million women’s and children’s lives by the end of 2015. While the outcomes were clearly formulated, the MDGs didn’t outline the best process to make this possible. One of the greatest lessons that working in development has taught us is that the process – how we strive to achieve our aims – is the most critical determinant of whether our efforts will be sustained. While discussions around what will replace the MDGs post-2015 are well underway, the health of women and children remains an unfinished agenda in many low-income countries. A recent analysis of global health suggests that maternal, newborn and child health conditions account for 38 per cent of potential lives lost in low income countries and yet only 17 per cent of health aid in these countries is spent on this priority.
The urgent need to address women’s and children’s health in Papua New Guinea
Just beyond Australia’s borders in Papua New Guinea (PNG), the rate of women dying in childbirth is still 80 times that of a woman giving birth in Australia. This is one of the highest levels of mortality associated with childbirth worldwide. Alarmingly, more than 5000 newborns die each year, with over a third of these not surviving beyond the first 24 hours, and a further 7000 children do not reach their fifth birthday. Considering that communicable diseases such as pneumonia, malaria, tuberculosis, syphilis, diarrhoeal diseases, meningitis and HIV account for 50 per cent of deaths each year in PNG, the normal state of pregnancy can easily be complicated by the coexistence of multiple illnesses. Such rates are even more intolerable given the loss of most of these lives could have been prevented with basic but effective interventions.
Persisting gaps in knowledge
There are still serious knowledge gaps in our understanding of how prevalent disease processes interact during pregnancy and what are the optimal models of providing and seeking health care in response. Burnet Institute undertook several studies to demonstrate that up to two-thirds of pregnant women living in highly malaria-prone areas are infected with malaria parasites; and that the incidence of tuberculosis (including multi-drug-resistant strains) is one of the highest in the Asia-Pacific Region. The true burden of disease is unknown, making the formulation of effective interventions challenging and uncertain. As a medical research institute that aims for practical action, Burnet Institute has responded through operational and implementation research to identify, test and prove better ways to deliver appropriate health care within rural and underserviced settings of developing countries such as PNG.
Burnet’s response: Healthy Mothers, Healthy Babies Program
The Healthy Mothers, Healthy Babies (HMHB) approach is directly addressing PNG’s high maternal and newborn mortality rate. Initiated by Burnet Institute in 2013 and with core funding from a network of philanthropic supporters, HMHB is a five-year effort developing new models of life-saving health care for women and children, starting from our research site in East New Britain. Burnet Institute has been working in this province for more than 10 years on improved services for pregnancy care, prevention and treatment of STIs and home-based management of malaria.
The main objective of HMHB is to generate evidence that will be of direct use to improve services and that can inform future health policy in PNG and similar settings. Articulated around five complementary studies, the program will quantify the major causes of illness in mothers, newborns and infants attending health care facilities and the relationship of illness in pregnancy to predicting poor pregnancy outcomes for mother and infant. Determinants of care utilisation during pregnancy and the first year of life will also be identified. Based on this evidence, effective strategies to improve maternal, newborn and child health services will be developed.
Collaborative research as a powerful development process
Through years of consistent presence in the province, strong and trusting relationships have been built with national and provincial health authorities, local health facilities and volunteer networks. Benefiting from these linkages, the HMHB program is engaging a wide range of local partners, enabling our five studies to be implemented with a strong focus on building local capacity in laboratory, research and quality improvement activities at the health facility, provincial and national level. We do not yet know which of the highest priorities to address, nor the details of what strategies will be successful. Neither do our partners. However, we anticipate that the process of finding this out together will lead to solutions that are locally relevant, sustainable, improve local capacity and may also be applied to similar settings internationally.
Burnet Institute strongly believes the promotion of collaborative research is critical to addressing health problems in the national and global contexts. Burnet Director and CEO, Professor Brendan Crabb AC, reaffirmed that: “the most effective and lowest cost interventions are those linking development assistance programs with high quality research”. Collaborative research should be considered as a powerful means to promote evidence-based public health policies and as a tool for real and sustainable change.
Ms Eliette Dupré-Husser is Project Manager for PNG, Centre for International Health, Burnet Institute. Dr Chris Morgan is Principal Fellow and Principal Investigator for HMHB Program, Centre for International Health, Burnet Institute. Dr Michelle Hendel is Senior Research Officer and Research Program Manager for HMHB, Centre for Biomedical Research, Burnet Institute.