1. Expanding beyond maternal clinics and wards to improve maternity and newborn care – Vanuatu experience. Dr Margaret Tarere

2. Country Profile Population: 234,023 (2009). Annual growth rate: 2.3 % (2009). 14% of pop under 5 years old, 21.5% are women of reproductive age (15 – 49) & 3.5% over 65 years of age. 76% of pop (rural) & 24% (urban) in 2009. Estimated CBR 31.1 per 1000 population & CDR was 5.5% (2008). Infant mortality rate was 27 per 1000 live births in 2008. MMR 86 per 100,000 live births (2007). Life expectancy 68 (males) & 70 (females).

3. Health Facilities 83 islands & 6 provinces. 5 public hospitals & 1 private hospital. 2 referral public hospitals: VCH (Port Vila) & NDH (Luganville). 27 Health Centers, about 4 in each province (RN & midwife) 97 Active Dispensaries (RN) & 231 Aid Posts (Village Health Workers). Vanuatu Archipelago

4. Human Resources Doctors 32 Ni – Van doctors. 3 Ausaid Consultants (2 Solomon & 1 NZ) 10 expats doctors including private doctors (French, Canadian, Chinese & Cubans). 1 doctor: 5,087 (pop). 2 Obstetricians – 2 @ VCH & None @ NDH. 1 Obstetrician: 25,168 (Females 15 – 49 years old). Midwives/Registered Nurses Total numbers of RN: 312. 1 nurse: 750 (population). Total numbers of midwives: 59. 20 midwives at VCH, 5 in ANC & 15 in labor ward (200+ deliveries/ month) & 10 NDH, 2 in ANC, 1 in NP training school & 7 in labor ward (100+ deliveries/month). Remaining 29 in 3 other Provincial Hospitals & Health Centers in the provinces. 1 midwife: 853 (Females 15 – 49 years old).

5. Continue… The bulk of the deliveries are handle at the H/C (52%), followed by the hospitals (40%). Around 8% of deliveries were conducted by TBA’s. 80% of the deliveries reported were attended by skilled health personnel. 95.5% of the newborn babies weighed more than 2500g.

6. CURRENT ACTIVITIES Provincial hospital visits twice annually to Tanna and Santo. Conduct CME’s for maternity staff at Lenakel & NDH. Facilitate ongoing programs on PMTCT, FP, BF, MCH etc in Tanna and Santo.

7. Breast feeding support group. Provide courtesy visit and teaching at the Nurse Practitioners school attached to the Northern District Hospital in Santo that has a maternal and neonatal care component.

8. Cont… For the remote northern region (Torba Province) there is an established flying doctor service (“ Wings of Hope’’) through a partnership with the SDA mission and the government (> 5 years). A Maul aircraft was used. The government provide subsidy for the aviation gas with VAT exemption. The doctor (Dr Mark Turnbull - GP) that service this remote Torba province is the pilot of the aircraft as well.

9. Cont… Dr Mark Turnbull Landing at Motalava Island bush airstrip.

10. OT BUILT BY Dr Mark @ Gaua Island. Pregnant mother with severe malaria treated at Gaua after flown in from Hiu island.

11. Cont… Dr Mark Turnbull (GP) doing an EMLSCS - twin pregnancy at Gaua Island. Dr Mark usually liaise with obstetricians about cases and the best possible outcome i.e. to fly pt to Santo or treat them in Gaua. Dr Mark has a small coulter counter (for FBC), mini lab & portable U/Scan available.

12. Cont… Obstructed labour from Toga island – the first island in the Vanuatu group, south of the Solomons. She was flown to Gaua and had EMLSCS – Maternal Death Avoided.

13. Future Activities Establish mobile clinics that will service Paunagisu H/C north of Efate (do T/L, Vasectomy etc). Conduct EMOC training for the Penama and Shefa province midwives, nurse practitioners and registered nurses. All other provinces has already received EMOC training. ALSO (Australia) training to be conducted for Vanuatu 2014/2015.

14. TANK YU TUMAS