The 'Reach Every Village' strategy for community-based health improvement interventions in the Momase Region of Papua New Guinea.

A principal difficulty in providing adequate health services to the rural and remote population of Papua New Guinea is the extremely high transport costs due to the difficult terrain. An operational strategy was needed to overcome the cost barriers to improving rural health. The World Health Organization's 'Reach Every District' (RED) strategy of decentralized capacity building was adapted to increase immunization coverage in a district or health centre catchment area. The strategy is a rigorous application of the microplanning technique used in community development, and is planning at the lowest unit of population. The operational components of the RED program for immunization, including planning, implementation and monitoring, can be readily adapted to other population-based interventions. However, where RED has been successfully introduced it has generally been in situations with easy access to low-cost transportation and so bundling programs is not a high priority. This paper describes the work undertaken to implement an expanded RED strategy, 'Reach Every Village' (REV), which is aimed at improving the health services provided in all health facility catchment areas, including aid post catchment areas, in the Momase Region of Papua New Guinea. The region's common characteristic is remoteness, with transport limitations resulting in some health facilities isolated for over three months. In such an operating environment, particularly with minimal resources, isolated staff and low staff morale, the all-program strategy has the potential to lead to effective and efficient population-based interventions which maintain and improve health. The strategy builds on previous public health and community interventions, which are integrated into the village health services model. Recent developments are discussed, together with future proposed community-based interventions, and management and resource implications.