Bringing health care to remote indigenous communities in Papua

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Health is a leading measure of development failure or success and health improvements bring significant economic benefits. Significant progress has been made in recent decades to increase life expectancy and reduce child and maternal mortality, malaria, tuberculosis, polio and the spread of HIV/AIDS. Mine workers may be exposed to increased occupational health risks such as cardiovascular and respiratory diseases (such as silicosis), as well as communicable diseases like tuberculosis and HIV/AIDS. All ICMM members implement the 10 principles that underpin our Sustainable Development Framework. Principle 5 requires companies to continually improve health and safety performance with the ultimate goal of zero harm.

When the UN’s Sustainable Development Goals (SDGs) officially came into force in January 2016, the nations of the world committed to mobilise efforts to end poverty, fight inequalities and tackle climate change. Business has a significant part to play, alongside governments and civil society, in creating pathways for a greener, safer and sustainable future for us all. Metals and minerals are essential to almost all aspects of everyday life; they enable farming, healthcare, communications, construction, transport and energy and water supply. And they will arguably become more important as they help to deliver the infrastructure required for a low-carbon future. This is one of a series of case studies gathered from our members to highlight how companies are working to enhance their contribution to society and help industry to manage potential adverse impacts their activities may have on the realisation of some of the SDGs.

With geographic isolation and limited government capacity to deliver health services, access to basic quality health care is a significant problem for many communities in the province of Papua in Indonesia.

Since 2016, PT Freeport Indonesia (PTFI) and its local development partner at the Grasberg Mine, LPMAK, have been addressing these challenges by working with the local government and an NGO health care provider to bring health services to communities in remote coastal areas through its floating clinic programme.

This partnership approach has succeeded in providing thousands of people with access to higher level of  basic health services for the first time and, in the process, has helped tackle some of the most serious health problems in the region,.

Partnerships and innovation to improve health outcomes in Papua

For much of Papua’s population, access to basic health care services is extremely limited and, in some areas, non-existent. The province has some of the highest rates of malaria, HIV/AIDs and tuberculosis in Indonesia, in addition to widespread incidences of diseases of poverty such as diarrhoea and respiratory illnesses. It is largely for these reasons that Papua has the lowest life expectancy and highest infant, child and maternal mortality rates in Indonesia.[1]

The floating clinic programme was established in 2016 to provide remote coastal communities in PTFI’s area of operation in Mimika Regency with quality basic health services.

The programme is part of PTFI’s Partnership Fund, a voluntary social investment programme funded with contributions equivalent to one per cent of the company’s gross revenue each year. The Fund has supported programmes focussing on health, education and economic development since 1996 and is managed by Lembaga Masyarakat Amungme and Kamoro (LPMAK), an organisation managed by seven local tribal groups.

The floating clinic programme plays an important role in supporting PTFI’s commitment to the Sustainable Development Goals (SDGs), particularly SDG 3 on ensuring healthy lives and promoting wellbeing for all.

The programme also aligns with SDG 17, partnerships for the goals. Rather than simply funding health services directly, PTFI and LPMAK have entered into a partnership with the Mimika local government health agency and a Non-Government Organisation (NGO) - Indonesian Christian Association for Health Services to address these challenges.

The NGO has dedicated six health professionals to the floating clinic programme including a General Practitioner (GP), midwife, nurse, lab analyst and general logistics personnel. The primary focus of this team is to strengthen the capacity of local government primary health care providers, as well as other health services providers, such as Mimika AIDS Commission, Mother and Child Health, Malaria Control, and Eye Health teams.

Importantly, the programme does not replace government health services, but rather strengthens and improves the quality and reach of them. It provides additional medical equipment, medicines, specialist expertise and is able to deliver them to remote communities.

The floating clinic is equipped with a patient treatment room, a minor operation room and several other health-supporting facilities. 

Specific services include:

The floating clinic service currently runs on a monthly basis, spending a total of 10-15 days in service, with 1-2 days in each location and reaching 3-5 villages each month. It presently services the eastern communities along the Mimika coast, with plans to commence services for the western communities in the future.

Achievements of the floating clinic programme

Since commencing operations in January 2016, the floating clinic has made over 15 visits to village communities located in the eastern coastal areas of Mimika and provided medical services and guidance to over 11,200 people in four districts.

These communities have received education on the importance of proper hygiene, TB, malaria, mother and child health, and nutrition. Nearly 5,000 cases have been examined and treated for health-related issues, including eye care. To date, 10 minor surgeries have been conducted, and 170 pregnant women have received prenatal care with access to ultrasound checks.

The floating clinic also provides logistical access for PTFI’s malaria prevention programs that has enabled indoor residual spraying of 1,234 households.  

To assess the effectiveness of the service, annual monitoring and evaluation of the programmes and associated activities is undertaken by LPMAK and PTFI health teams to ensure frequency, accessibility and quality of health care services is maintained.

A baseline data set has been developed to track the progress of health programmes against key performance indicators and community health issues that are linked to local and national government health targets. These targets reflect the SDG health indicators 2030 agenda for communities living in villages, including 90% of pregnant women to receive midwifery services, 100% child immunization/vaccination and 100% of malaria sufferers to receive medicine.

Looking ahead – closer collaboration with local government

Once fully operational, the floating clinic service will cover an area spanning approximately 300 kilometres, with key service areas located at: Manasari and Jita to the east; and Atuka, Amar, Wakia and Potowayburu to the west of PTFI’s contract of work area. In doing so, this service will meet the primary health care needs of approximately 25,300 people.

In addition to extending the current service area to the western communities of Mimika Regency, PTFI and LPMAK are working with local government health agencies towards securing a long-term sustainable development plan whereby local government will assume responsibility for the operational costs in providing the floating clinic service. It is also intended to integrate local government health representatives to become part of regular monitoring and evaluation activities carried out in the villages.

ICMM members supporting the SDGs