Social Evaluation Study for the Milne Bay Community-Based Coastal and Marine Conservation Program png/99/G41 Jeff Kinch April 2001 unops contract for Services Ref

The isolation of many smaller islands in the area and the scattered nature of the population means that some people live several hours from any health centre. A list of Aidposts in Zone 1 is given in Appendix 4. A program of training village-based health workers paid by the LLGs, has been instituted to alleviate this problem.

In the 1982/83 National Nutritional Survey (NNS), Milne Bay Province had five of the worst 15 districts in the country, namely Rabaraba, Alotau, Esa’ala, Misima and Losuia. The Misima District, encompassing portions of CBMMCAs 2 and3 had 62% of its under five population below 80% body weight for their age. The Provincial average at this time was 38.3% (Department of Milne Bay, 1990). In 1994 this had dropped to 49% (UNICEF, 1997). In 1978 the National Nutrition Survey was conducted and reported the West Calvados Islands (CBMMCA 3) with the lowest incidence of malnutrition at 16.39%, while Sudest showed 59.8% and Rossel 36.64%. These figures were checked by the Milne Bay Provincial Health Authorities in another survey later that same year and produced even more startling figures; the West Calvados was now 73%, Sudest and 52% Rossel 77% making it the most malnourished place within the Province (Lepowsky, 1979). An IFAD nutritional survey in 1979 found that Tubetube (CBMMCA 2) children were among the best nourished in the Province (see Leonard, 1979).

Most malnutrition occurs within the first three years of a child's life. A child with malnutrition is more susceptible to infections and diseases. Traditionally colostrum was not given to the newborn baby thereby making them more prone to infection. Iron deficiency anaemia is common amongst older children, particularly those exposed to repeated malaria attacks and worm infestations. Malnutrition amongst women is often due to inadequate intake of energy and protein foods. Men usually have first call on available food. In the past, food taboos affecting young children and pregnant women were common. The most regular food source for families within the CBMMCAs comes from starchy, nutrient-poor root crops such as yams and tapioca.

Even though child malnutrition has dropped in recent years this is attributed to intervention by the United Nations Childrens Fund through their Community-based Best Practices for Child Survival and Development Program, particularly in the Esa'ala District. Child nutrition has not improved in the Samarai-Murua District over the last five years but remains proportionately low at 1.1%. On the other hand, low birth weight remains constantly high.

In 1996 Harmony Ink conducted priority-setting workshops for communities in the Misima District. From these workshops communities stated the following to be their major problems. In order of importance these were (i) inadequate toilet facilities and sanitation; (ii) family planning information and materials on nutrition; (iii) poor water suply; (iv) village hygiene; (v) water pollution; and (vi) lack of visits from CHWs and shortage of drugs in Aid Posts (Jackson, 2000). The emphasis by the people themselves on family planning is indicative of the already high level of community awareness of population growth and its potential problems for the CBMMCAs.

Generally, the health status of people in the Province has been on the decline over a period of 20 years due to a lack of sufficient financial and manpower resources to effectively implement various health care programs (MBA, 2000). The MBP may have a part to play in health promotion to improve local villagers’ health status. Reducing the level of resources required to keep people healthy (through promotion of primary health care services and prophylactic devises such as mosquito nets) may reduce harvesting pressure on commercially valuable species. This could be done by decreasing the amount of direct expenditures spent on health care in the short-term and by reducing the population growth rate as life expectancy increases over the long-term.

In 1998 the MML and the World Health Organisation (WHO) began the filariasis elimination program that has been expanded to the whole of the Samarai Murua District.

The trend has been for increased immunisation coverage throughout Zone 1, for example TA 3 (Triple Antigen) has gone from 60% in 1995 to 52% in 1997 to a high of 73% in 1999. Similarly, MEA 9-11 (Measles Immunisation) went from 46% in 1995, slumping to 27% in 1996 and slowly rising up to 58% in 1999.

There are normally at least two permanent buildings in each community within the CBMMCAs. These are the Community Hall, usually built under the Tax Credit Scheme by MML, and a Church building, which is funded either by community donations and/or government funds. Microwave radiotelephones are located at East Cape and Nuakata (CBMMCA 1), Tubetube and Panaeati (CBMMCA 2), and Ware and Brooker (CBMMCA 3). These phones are an obvious benefit to these communities. People can arrange trading expeditions and other business prior to sailing, they can contact kin in other areas at times of death or emergency, and help in the coast watch for canoes that have encountered bad weather. One possible negative side affect in the enhanced communications is the ordering of turtles from Brooker (CBMMCA 3) to be brought to Misima for trade or Christian festivals. VHF Radios (5885 kHz) are located at Samarai, Dawson and Ware (CBMMCA 3).

Most islands in Zone 1 have a scarce supply of fresh water both for domestic and agricultural use, particularly Ware and Brooker (CBMMCA 3). Since 1983, 313 water supply units/systems have been installed in the Province. This represents 55% coverage of the Province. In 1999, diarrhoea caused by unsafe water supply resulted in a mortality rate of 1.5/100000 (Division of Health, 2000). Only 30% of the rural population has access to safe and proper excreta disposal systems (Division of Health, 2000). In the 1996 Harmony Ink conducted priority-setting workshops for communities in the Misima District. The number one priority for these communities was inadequate toilet facilities and sanitation and number three was poor water supply.