Applying Kabeer's Social Relations Approach to Village Health Volunteers in Rural Papua New Guinea

In this thesis I explore the effectiveness and sustainability of the Village Health Volunteer system within the East Sepik Women and Children's Health Project (ESWCHP), Papua New Guinea. The ESWCHP is a well-established project that provides a health infrastructure for primary health care services in rural areas of the East Sepik Province. The ESWCHP supports Church Health Services, and village women who volunteer (Village Health Volunteers) to provide primary care in rural village settings. In 2006, I undertook research to assess the impact of the ESWCHP. The assessment showed that rural people were very supportive of the Project and that it had made a significant, positive difference to health in rural villages. There was however, an overwhelming response to the research from Village Health Volunteers (VHVs) with requests for a greater level of support from rural people and the ESWCHP (in terms of training, payment, and status) and greater consistency of medical supplies. In this qualitative thesis research, I revisited the 2006 data using a combined theoretical frame of gender and development, participatory development and Sen's capability approach. I developed a detailed method based on Kabeer's Social Relations Approach (1994) to guide the process of interpretation, analysis and representation of memories, notes, and data. Through the analysis of social relations, I examined questions concerning the effectiveness of the VHV system in the face of escalating maternal death rates and epidemic levels of HIV/AIDs, and its sustainability. The analysis showed that the ESWCHP was facing compounding gender inequalities that put sustainability of the VHV system at risk. The analysis also showed that on the basis of key health indicators, the ESWCHP health infrastructure with its current heavy reliance on VHVs was neither successful nor effective. Research is urgently needed to identify a sustainable and effective model of rural health care to address the rapidly escalating maternal death and HIV rates of rural people in PNG.