Women in Papua New Guinea are dying in childbirth at 23 times the New Zealand rate. That is 1500 women dying preventable deaths every year, and 30% of them are teenagers.
It is one of the most shocking indicators of a country in crisis. The maternal death rate in PNG, one of our closest neighbours, is on a par with Afghanistan. And there is no sign of improvement.
PNG has its share of problems: poverty, HIV/AIDS epidemic, corruption, and appalling governance. It’s the last on that list that is the big driver. The failure of the state to provide basic health services to its citizens is what has caused the skyrocketing rates of women dying in childbirth.
PNG health workers at a parliamentary hearing today on maternal health in the Pacific testified the key factors behind the figures are the collapse of rural health services, and now a dire shortage of trained midwives.
Foreign Minister Murray McCully likes to rail against aid to Pacific nations’ public sectors but the failure of the PNG public service to train midwives over the last decade has directly caused the preventable deaths of thousands of women in childbirth and heaven knows how many children. Submitters at today’s hearing told how the PNG government decided in 2001 to shift all midwife training into universities but failed to put a curriculum in place. Since then no midwives have been registered.
Helping Pacific governments deliver services effectively, and be accountable to their citizens is exactly what our aid programme should be doing.
It is not rocket science. In the neighbouring Solomon Islands, maternal deaths went through the roof after political instability in the late 1990s saw a break down in health services. Since then the Solomon Islands public health system has cut maternal deaths by two-thirds mainly by focusing on training and deploying midwives and healthworkers.
Samoa is the success story of the Pacific in this area. It has achieved some of the lowest maternal death rates in the region, and this is widely attributed to a reformed public sector health service working alongside traditional birth attendants, good workforce planning and investment in training.
The same pattern is found further afield. The international stand outs in this area are Sri Lanka, Thailand and Malaysia who all recorded massive improvements in maternal death rates by investing in midwife training. Sri Lanka in particular made midwife services free to those who could not afford to pay, expanded access in under-served rural areas, increased training of midwives, and raised awareness of women’s right to skilled birth attendants.
New Zealand’s taxpayer-funded development agency NZAID is doing the right thing in PNG. It supports the national department of health, and a midwife training programme run by the World Health Organisation, as well as a number of groups delivering health services at community level.
But here’s the rub. The new direction of the NZ aid programme driven by Foreign Minister Murray McCully flies in the face of this evidence from crisis-ridden PNG. It is hard to fathom the Minister’s desire to shift the balance of funding from Melanesia which is home to appalling social indicators and acute poverty on a massive scale, to Polynesia which already enjoys one of the highest rates of aid per capita in the world and relatively good social indicators.
But most of all the new mandate to focus on private sector economic development and free trade will do nothing to reduce the rate of mothers dying in childbirth. Or kids missing a primary education. Or people without access to clean water.
The Minister needs to get over his ideological hostility to the public sector and recognise that improving governance and helping people hold their governments accountable is the immediate challenge if the Pacific is to tackle its appalling social indicators, like the rate at which mothers are dying in childbirth in Papua New Guinea.
Mr Twyford, I suppose your post begs the question, after nine years of Labour government, what good did New Zealand government policy do to improve the lot of women in PNG?
I was hoping you’d ask that Tim. During those nine short years Labour reformed an under-performing, mediocre overseas aid programme staffed by junior diplomats and built it into a smart development agency run by professional development specialists, widely recognised as being up with international best practice, focused on poverty elimination and doing some innovative work particularly in the Pacific. That progress is somewhat under threat now due to this Government’s decision to merge NZAID back into the Ministry of Foreign Affairs, and to politicise it by explicitly aligning it with diplomatic and political interests, directing its focus away from poverty and on to supporting private sector economic development and the Government’s free trade agenda.
Mr Twyford, I understand that the last Labour Government certainly spent a lot more money on overseas aid, although the internal benefits that you mention of a better structure delivering “widely recognised” “best practice” is a bit dubious.
You might have been aware of the report of the Foreign Affairs and Defence Select Committee last year, which noted:
Those issues seem to directly challenge your claim that things are humming along very well with the agency.
I note however that you didn’t really address my direct question, which was specifically despite the increase in funding under the last nine years of the last Labour Government, how has New Zealand delivered better outcomes for women in PNG?
It is all very well to talk about more inputs and restructuring, but I’m interested in effective outputs.
and how is Murray McCullys fault.
You say the rot set in in 2001 when mid wife training was transfrred to Universities.
Sorry but wasnt Mr Goff foreign minister then?.
Even so what reponsibility would that have been of Mr Goffs let alone Mr McCullys.
Phil – a more useful answer would be to detail the total spending in PNG by NZ Aid over the last decade, and what impact this has had on the childbirth death rate for women.
Also more useful than a general rant would be to tell us how much was spent on PNG previously, and how much the current Government has allocated towards it. Has it changed?
Yes it will – it should eventually provide the income for the people to address their needs themselves and according to their own priorities.
Mr Twyford, as for your claim:
I would be interested to see if Mr Robertson’s assessment of New Zealand’s aid before the Labour government concurs with yours, as I understand Mr Robertson worked in the aid section of MFAT at that time.
Are you really accusing McCully of causing the deaths of babies ! Labour were in power for the 9 years referred to and with huge surpluses to boot, why not buy yourself a mirror.
Mr Twyford, I see that my last comment was placed in moderation. Is it because I included a quote? I assume this is the case because my comments on Mr Mallard’s thread don’t appear to be moderated.
That sounds really bad.
@ Tim Ellis 12.57pm – I am aware of the Auditor General’s report. I was also at the committee this year when Gareth Ellis told us that NZAID had invested considerable resources in sorting the problems, and that they were well on the way to solving them to his satisfaction. Murray McCully has repeatedly used the problems the Auditor General highlighted as justification for merging NZAID back into MFAT – ignoring the facts that NZAID moved swiftly to deal with the admininstratve problems, and ignoring two glowing independent organisational reviews of NZAID. One by the OECD, and the other done for Cabinet by Dr Marilyn Waring.
@ Mark M, David – Read the post. I am not blaming Murray McCully for PNG’s maternal death rates. I am saying that PNG has this appalling maternal death rate problem, and the principal cause is governance or the break down of the state. This is an extreme example but the principle applies across much of Melanesia. The point is that private sector economic growth (the new much-heralded priority of the Government’s aid agenda for the Pacific) is not only not a panacea for PNG, it comes quite a long way behind improving governance, as an effective strategy to address the human costs of PNG’s crisis.
Having a more businees like appraoch to aid where little is forthcoming until necessary reforms are in place is a welcome approach from NZ, finally. No point in spraying money around as has been the case for the last 9 years with little discernable results.
As other donor countries have done you reward well behaved countries as your bang for the buck is much higher and doesnt line the pockets of the elite. Labour happily cut off Fiji which is a virtual paragon of virtue compared to PNG.
@ David Farrar – NZ’s aid spend in PNG has gone from $10 m in 2000/01 down to $7 m in 2002/03 and up to $16 m last year and $22 m this year. Only some of this in recent years has been targeted to reducing maternal and child death rates. During that time we have seen maternal death rates go through the roof as PNG’s public health system has gone into decline.
You’d have to look at NZAID’s specific programme evaluations to see what kind of impact they had in terms of saving lives. But it would be a mistake to argue, as Murray McCully does, that NZAID programmes haven’t stopped things getting worse in the Pacific therefore NZAID is a failure. NZAID this year spends $22 m in PNG, and only a few million of that on health. PNG spends more than a billion dollars on its health system each year, with only about 10% coming from external sources like aid. It is pretty clear from the evidence presented at today’s hearing http://www.rnzi.com/pages/news.php?op=read&id=49231 that PNG needs to train more midwives. Donors like NZAID should get on and help them to do that.
@ David 5.12 – Agree we should back reform minded governments and invest in success. And that when Governments cross a certain line (like Mugabe for instance, or Bainimarama closer to home) government to government aid should stop. However brute conditionality as practised by the World Bank and IMF through the 80s and 90s has been pretty much discredited. It just doesnt work. In a country like PNG it wouldnt work because it is not a case of a corrupt regime determinedly lining its pockets like Suharto or Mobutu. It is more a case of systemic break down. There are plenty of good public servants and some politicians in PNG that donors like NZ can and do work with to improve things.
Im all in favour of NZAID being business like, and notwithstanding the problems identified by the Auditor General and mentioned above, they are as a rule. I’m more concerned by the current Government’s direction muddying their mandate and making them less accountable for outcomes – Treasury argued this earlier this year but McCully and Co ignored them.
Mr Twyford, if governance issues are at the core of PNG’s humanitarian crisis, then what stick do you have left to beat the PNG government with if they don’t do anything about cleaning their act up if you don’t link aid to foreign policy goals?
I think what you have inadvertently shown is that despite pouring a lot more money into PNG, the NZ government hasn’t done anything to improve the plight of PNG women (other than a feel good factor for NZ politicians), yet the governance issue in PNG has deteriorated.
I’m less concerned about inputs than I am outputs. I don’t really think you’ve demonstrated any positive link impact with the separation of development policy from foreign policy. In fact I think you’ve shown the opposite.
You haven’t substantiated the claim that New Zealand’s aid agency was poorly performing prior to the Labour Government reforms, which suggests to me that it was a lot of hot and empty rhetoric on your part.
Labour has had nine years to train midwives in PNG. Why didn’t it do it? Given the more than doubling of money on aid to PNG, I don’t think if this is the highest development priority for PNG, you’ve got much of a defence for a government that failed to do it. Why wasn’t NZAID aware of this pressing need?
With all due respect the title of this post is dog whistling at its most destructive. It isn’t constructive for you to suggest that Mr McCully doesn’t care about dying women in PNG. By your own measure you would have to say that equally the last Labour government didn’t care about dying women in PNG. You would no doubt find that accusation offensive, which it is. I might suggest if you want to maintain credibility then you might engage in constructive debate rather than howling at the moon.
@ Tim Ellis
1. Linking aid to foreign policy goals is not going to help get the PNG government to clean up its act. What will work is working in coordination with other development donors, backing reformers within the PNG government, and having clear and sensible strategies. PNG has shown repeatedly over the years that it can cheerfully ignore any amount of stick waving by Australia or anyone else.
2. If you dont believe that NZ’s aid programme was poorly performing before 2000 read the Lees-Grossman review (2000) which led to the formation of NZAID. It will make your toes curl.
3. Tim, you need to get over your “nine long years” fixation. My argument is simply that the Government’s idea of private sector development as some kind of panacea is not going to do much to solve the really difficult development challenges in Melanesia, which are really all about governance.
Phil, I’ve been impressed with your responses here, and your understanding of the issues, as would be expected for a man of your background (and I’m not just saying that – I’m very often a staunch critic).
It’s a pity that countries like PNG are being neglected so that National’s NZAID can work on countries a number of steps up the human development index. It appears from here that the move is designed to maintain NZ’s influence over those parts of the Pacific as much as anything, and the idea that lack of trade is the cause of low human development. It is, but it is also a symptom of it. It’s pretty hard to make economically useful things when you’re incapacitated with malaria, or dying in childbirth.
Reasoned responses, Phil. It would be pleasing to see recognition of the case you make from the critics who took aim so readily.
Tim Ellis, where are you now? The headline was dramatic, but a reasonable statement of a likely outcome of this government’s policy shift. As a dog owner, I can aver that it was certainly not dog whistling -it was a plain speech utterance.
“The New Zealand government aid agency, NZAID, says it will look at a request for funding to boost training for reproductive health workers in Papua New Guinea, but says it’s already helping to strengthen the country’s health system.”
http://www.rnzi.com/pages/news.php?op=read&id=49243
Tim: For the record I was indeed working in the Aid Division when it was part of MFAT, and I have said publicly that while everyone there worked hard I do agree that the aid programming was under-performing and at times poorly focused. Also we had very few developments specialists. We did not work well with other countries and political considerations did get undue weight from time to time. Within this there were things that worked well, and some of the success in Samoa in the areas Phil is writing about are down to health projects initiated by NZ and Samoa together. Overall of course we did good things with NZAID within MFAT, but I think on balance far better things were being acheived with the expertise, focus and independence provided by the semi-autonomous structure.
[...] hearing at Parliament convened by the Parliamentarians for Population and Development uncovered the appalling rate at which women in Papua New Guinea are dying in [...]