Angela Kelly-Hanku

Tuberculosis (TB) is a major global public health challenge. Despite being preventable and curable, TB remains the leading cause of death caused by a single infectious agent worldwide (W. H. O, 202...

Introduction: Transport, including public transit, is essential for promoting health and preventing illness and death. The connection between geography, travel, transportation, and health has consistently been linked to health equity. This qualitative study examines the relationship between transport and access to and delivery of health care during the COVID-19 pandemic in Papua New Guinea. Methods: In total, 131 healthcare workers, healthcare clients, community members, leaders, and stakeholders in health policy and management were recruited to participate in semi-structured interviews across seven provinces. Data analysis employed both deductive and inductive thematic approaches to explore transport accessibility, availability, and affordability during the pandemic. Results: In PNG, COVID-19-related transport shutdowns, movement restrictions, decreased passenger numbers on public transport, and an aging or unavailable healthcare fleet created substantial barriers to accessing and delivering healthcare. These transport barriers impact not only rural and remote populations but also urban and peri-urban communities. The mobility of healthcare workers was also hindered, directly affecting healthcare delivery—an issue not observed in previous pandemics. Conclusion: These findings support the immediate prioritisation of transport in health planning, frameworks, and budgets, as well as the development of collaborations and partnerships with public transport to better prepare for and respond to future health pandemics and emergencies.

The lessons learned from the COVID-19 pandemic are essential for implementing substantive changes and present a significant opportunity to strengthen the resilience of health systems on both national and global scales in responding to future public health crises. It is widely acknowledged that COVID-19 vaccination represents one of the most effective strategies to contain the pandemic. Nonetheless, vaccine hesitancy continues to evoke fear and uncertainty, particularly in contexts such as Papua New Guinea (PNG), a nation characterised by one of the lowest COVID-19 vaccination rates worldwide. Insights from previous public health interventions in PNG emphasise the critical role that community leaders play in ensuring the success of such initiatives. This publication reports on a study investigating the influence of community leaders on COVID-19 vaccine uptake in PNG. Qualitative research was carried out across seven provinces between July and November 2021, involving interviews with 131 participants, including healthcare professionals, key informants, community leaders, and primary health service clients. There was considerable support for community-led strategies, with participants advocating for awareness programs to be delivered by community leaders. The advantages of locally driven approaches include the trust communities place in their leaders and shared lived experiences, which enable them to address their specific needs effectively while respecting and building upon local beliefs and customs. The effectiveness of place-based vaccine champions was also endorsed, recognising the importance of collaborations between health systems, governments, and community leaders to promote COVID-19 vaccination. These findings underscore the importance of sustained support and ‘bottom-up’ strategies to empower community leaders in fostering community ownership of health promotion initiatives and building resilient health systems, not only for COVID-19 vaccine distribution but also for future health interventions.

Objective: People with physical disability experience systemic and societal barriers to accessing cervical screening. Service providers play an important role in supporting access to cervical screening for this population. In 2017 Australia’s National Cervical Screening Program introduced the choice to self-collect using a vaginal swab, with universal access available from July 2022. This study aimed to understand service providers’ perspectives on the opportunities self-collection provides to improve access to cervical screening for people with physical disability. Methods: Semi-structured interviews were conducted online between June and August 2023 with 22 clinical and non-clinical service providers from all States and Territories except the Northern Territory. The Updated Consolidated Framework for Implementation Research informed the analysis. Results: All participants believed that self-collection was a highly acceptable option, both for people with physical disability and service providers, due to its potential to reduce anxiety and discomfort for screening participants, and the opportunities it provides to increase access to screening in non-clinical settings, including at home and in supported accommodation. To date, few services providing disability support had integrated self-collection into their practice. Key barriers to offering self-collection included confusion regarding whether cervical screening was within all provider’s scope of practice, a lack of communication between the health system and the disability sector and an absence of education and resources for providers and people with disability. Attitudes toward people with disability held by healthcare providers, such as general practitioners and other health and wellbeing services, and the quality of relationships between services were seen as either barriers or enablers depending on whether these were positive or not. Several providers expressed concern that the swab may be difficult for some people with physical and sensory disability to use, with adaptations recommended. Conclusion: Self-collection offers opportunities to improve access to cervical screening for people with physical disability, if supported by providers who have the required knowledge and skills. Implementation strategies to support uptake of self-collection for people with physical disability are required at the individual, device, service, and system level.

Since 2022, Australia’s National Cervical Screening Program has recommended that anyone eligible for cervical screening should be offered the choice

Using a sociomaterial perspective based on interviews with health workers, we examine how clinic-based HIV viral load testing and early infant diagnosis technologies reshape health care realities in Papua New Guinea. The use of such technologies redefine professional roles and health care experiences by empowering health workers to translate biomedical data into client-centered clinical management, while also contributing systemic tensions, such as the paradoxical recentralizing of care and heavier workloads. Despite these challenges, health workers view these clinic-based technologies as transformative tools that support ethical decision-making, reduce preventable deaths and expand equitable health care.

Background: Health workers in many low- and middle-income countries are not adequately trained to provide quality antenatal and intrapartum care. The freely available Safe Delivery App (the App) provides health care professionals with direct and instant access to evidence-based, up-to-date clinical guidelines equipping them with an on-the-job reference guide, even in the most remote areas. In this paper we describe the uptake and acceptability and the process to align the App in Papua New Guinea (PNG). Methods: Between June 2022 and December 2024, quantitative and qualitative methods were used to explore the usage and acceptability of the App among health care workers in PNG, re-designing images and aligning clinical content with PNG national clinical guidelines. Dissemination of the App took place through formal and informal networks, including a training of trainers’ program in one province. Results: The App was seen as an acceptable and useful tool among midwives and nurses working clinically, particularly those in remote areas and midwifery educators. There was an increase in the use of the App, from 354 registered users in 2022 to 1304 in 2024. The majority of users were midwives and nurses, working in primary health care facilities and nursing and midwifery establishments. Participants reported that the App has led to changes in practice, supporting and encouraging staff to follow evidence-based guidelines, improving their clinical management. Conclusion: The Safe Delivery App is seen as a useful tool, supporting clinical practice, knowledge and skills, providing users with more confidence in their ability to provide quality maternal and newborn health care. Wider implementation of the App across PNG may be a potential way to support health care workers in the remote settings, providing up to date evidence based clinical guidance in the absence of skilled midwives and doctors.

Health equity is a fundamental concern within the broader health promotion aim of creating equal opportunities for health and bringing health differentials down to the lowest level possible. Cervical screening is just one example of a preventative health program where a health promotion lens is required to address entrenched health inequities. We draw on theorizations of policy ecologies to provide a framework for better understanding the processes involved in operationalizing policy with greater inclusivity in language in health promotion. Twenty-eight semi-structured interviews were conducted with 29 key informants between April and October 2022 to explore the operationalization of inclusive language in health promotion in the context of a national program to promote cervical screening to currently underscreening communities in Australia. Four thematic categories emphasize the balance required between demands and domains: (i) the need for clinical guidelines and flexibility in their translation and interpretation; (ii) organizational mandates, clinical practice, and patient-centred care; (iii) socio-cultural norms, behaviours, and attitudes amid politicized/ing milieus; and (iv) community preferences and the need for medical accuracy. As such, we identified how the operationalization of inclusive language in policy is influenced by and influences other domains where cervical screening is promoted. These findings hold wider implications for how the historical legacies of and contemporary need for ‘women’s health’ can be maintained and respected amid demands for greater gender inclusion. At the same time, the failure to trace diverse and diffuse modes and contexts of operationalization may (re)produce health inequities in practice if left unexamined.