Proposal: Midwifery Workforce Planning and Retention Strategies for Improving Maternal Health Outcomes in Rural Papua New Guinea
Full PhD Research Proposal
Proposed Title
Midwifery Workforce Planning and Retention Strategies for Improving Maternal Health Outcomes in Rural Papua New Guinea
Midwifery Workforce Planning and Retention Strategies for Improving Maternal Health Outcomes in Rural Papua New Guinea
1. Introduction
Maternal health remains a major public health concern in Papua New Guinea (PNG), particularly in rural and remote communities where access to skilled maternity care is limited. Despite efforts to strengthen maternal healthcare services, maternal mortality remains high compared to many countries in the Pacific region (World Health Organization [WHO], 2021).
A major challenge affecting maternal healthcare delivery in PNG is the shortage and unequal distribution of skilled nurse-midwives. Rural health facilities frequently experience staffing shortages, high workloads, limited professional support, and poor retention of qualified midwives (WHO, 2021). These workforce challenges reduce access to skilled birth attendance and contribute to poor maternal health outcomes (United Nations Population Fund [UNFPA], 2021).
Effective workforce planning is critical to ensuring adequate recruitment, deployment, and retention of nurse-midwives in underserved areas (WHO, 2016). However, there is limited research examining sustainable workforce planning approaches for maternal health services within the PNG healthcare system.
This study aims to investigate midwifery workforce planning challenges and identify practical retention strategies that can improve maternal healthcare delivery in rural Papua New Guinea.
Maternal health remains a major public health concern in Papua New Guinea (PNG), particularly in rural and remote communities where access to skilled maternity care is limited. Despite efforts to strengthen maternal healthcare services, maternal mortality remains high compared to many countries in the Pacific region (World Health Organization [WHO], 2021).
A major challenge affecting maternal healthcare delivery in PNG is the shortage and unequal distribution of skilled nurse-midwives. Rural health facilities frequently experience staffing shortages, high workloads, limited professional support, and poor retention of qualified midwives (WHO, 2021). These workforce challenges reduce access to skilled birth attendance and contribute to poor maternal health outcomes (United Nations Population Fund [UNFPA], 2021).
Effective workforce planning is critical to ensuring adequate recruitment, deployment, and retention of nurse-midwives in underserved areas (WHO, 2016). However, there is limited research examining sustainable workforce planning approaches for maternal health services within the PNG healthcare system.
This study aims to investigate midwifery workforce planning challenges and identify practical retention strategies that can improve maternal healthcare delivery in rural Papua New Guinea.
2. Background of the Study
Papua New Guinea has a geographically dispersed population with many communities located in hard-to-reach rural areas. Access to healthcare services remains difficult due to transportation barriers, inadequate infrastructure, and shortages of healthcare professionals (National Department of Health PNG, 2021).
The shortage of nurse-midwives has become a major obstacle to improving maternal health outcomes. Rural health facilities often operate with limited staff, and many trained midwives prefer urban postings because of better living conditions, career opportunities, and access to resources (WHO, 2021).
Existing workforce planning systems may not adequately address staffing distribution, rural deployment, professional development, workplace support, and retention of midwives. As a result, many rural women continue to experience limited access to skilled maternity care during pregnancy and childbirth (UNFPA, 2021).
Strengthening workforce planning strategies may improve the availability of skilled midwives and support national maternal health goals in PNG.
Papua New Guinea has a geographically dispersed population with many communities located in hard-to-reach rural areas. Access to healthcare services remains difficult due to transportation barriers, inadequate infrastructure, and shortages of healthcare professionals (National Department of Health PNG, 2021).
The shortage of nurse-midwives has become a major obstacle to improving maternal health outcomes. Rural health facilities often operate with limited staff, and many trained midwives prefer urban postings because of better living conditions, career opportunities, and access to resources (WHO, 2021).
Existing workforce planning systems may not adequately address staffing distribution, rural deployment, professional development, workplace support, and retention of midwives. As a result, many rural women continue to experience limited access to skilled maternity care during pregnancy and childbirth (UNFPA, 2021).
Strengthening workforce planning strategies may improve the availability of skilled midwives and support national maternal health goals in PNG.
3. Problem Statement
Papua New Guinea continues to face significant shortages of nurse-midwives, particularly in rural and remote provinces where maternal health services are most needed (National Department of Health PNG, 2021). Weak workforce planning systems, inadequate deployment mechanisms, and poor retention strategies contribute to unequal distribution of skilled maternity care providers.
Without sustainable workforce planning, maternal mortality reduction efforts may remain limited despite ongoing investments in healthcare services and training programs (WHO, 2016).
Currently, there is insufficient evidence regarding effective workforce planning and retention strategies specifically designed for the PNG maternal healthcare context.
Papua New Guinea continues to face significant shortages of nurse-midwives, particularly in rural and remote provinces where maternal health services are most needed (National Department of Health PNG, 2021). Weak workforce planning systems, inadequate deployment mechanisms, and poor retention strategies contribute to unequal distribution of skilled maternity care providers.
Without sustainable workforce planning, maternal mortality reduction efforts may remain limited despite ongoing investments in healthcare services and training programs (WHO, 2016).
Currently, there is insufficient evidence regarding effective workforce planning and retention strategies specifically designed for the PNG maternal healthcare context.
4. Aim of the Study
To explore midwifery workforce planning challenges and identify sustainable strategies for improving recruitment, deployment, and retention of nurse-midwives in rural Papua New Guinea.
To explore midwifery workforce planning challenges and identify sustainable strategies for improving recruitment, deployment, and retention of nurse-midwives in rural Papua New Guinea.
5. Research Objectives
- To examine factors contributing to shortages of nurse-midwives in rural Papua New Guinea.
- To assess current workforce planning and deployment practices within the PNG health system.
- To explore challenges affecting retention of nurse-midwives in rural health facilities.
- To identify sustainable workforce planning strategies that may strengthen maternal healthcare delivery in PNG.
- To examine factors contributing to shortages of nurse-midwives in rural Papua New Guinea.
- To assess current workforce planning and deployment practices within the PNG health system.
- To explore challenges affecting retention of nurse-midwives in rural health facilities.
- To identify sustainable workforce planning strategies that may strengthen maternal healthcare delivery in PNG.
6. Research Questions
- What factors contribute to midwifery workforce shortages in rural Papua New Guinea?
- How effective are current workforce planning and deployment systems in PNG?
- What challenges influence retention of nurse-midwives in rural healthcare facilities?
- What workforce planning strategies can improve maternal healthcare outcomes in PNG?
- What factors contribute to midwifery workforce shortages in rural Papua New Guinea?
- How effective are current workforce planning and deployment systems in PNG?
- What challenges influence retention of nurse-midwives in rural healthcare facilities?
- What workforce planning strategies can improve maternal healthcare outcomes in PNG?
7. Significance of the Study
The study is important because it may:
- support evidence-based workforce planning,
- strengthen maternal health service delivery,
- improve distribution of skilled birth attendants,
- support rural healthcare systems,
- and contribute to reducing maternal mortality in Papua New Guinea.
The findings may also assist:
- the PNG National Department of Health,
- provincial health authorities,
- nursing and midwifery schools,
- healthcare policymakers,
- and international development partners.
The study aligns with global health workforce priorities identified by the WHO Workforce 2030 Strategy (WHO, 2016).
The study is important because it may:
- support evidence-based workforce planning,
- strengthen maternal health service delivery,
- improve distribution of skilled birth attendants,
- support rural healthcare systems,
- and contribute to reducing maternal mortality in Papua New Guinea.
The findings may also assist:
- the PNG National Department of Health,
- provincial health authorities,
- nursing and midwifery schools,
- healthcare policymakers,
- and international development partners.
The study aligns with global health workforce priorities identified by the WHO Workforce 2030 Strategy (WHO, 2016).
8. Literature Review
Global evidence demonstrates that shortages of skilled healthcare workers significantly affect maternal and neonatal outcomes, especially in low- and middle-income countries (Campbell & Graham, 2006).
The WHO identifies health workforce shortages as a major barrier to achieving universal health coverage and reducing maternal mortality (WHO, 2016). Studies have shown that the availability of skilled birth attendants is associated with improved maternal survival and reduced childbirth complications (UNFPA, 2021).
Research from rural and remote healthcare settings indicates that workforce retention is influenced by working conditions, professional support, accommodation, career advancement opportunities, incentives, and safety concerns (Lehmann, Dieleman, & Martineau, 2008).
According to Lehmann et al. (2008), rural retention strategies should include both financial and non-financial incentives to improve workforce stability in underserved areas.
In Papua New Guinea, maternal health indicators remain poor compared to neighboring Pacific countries. Rural communities continue to experience difficulties accessing skilled maternity services due to workforce shortages and geographic barriers (National Department of Health PNG, 2021).
Although healthcare workforce challenges in PNG have been discussed in policy reports, there remains limited empirical research focusing specifically on midwifery workforce planning and rural retention strategies.
This study therefore seeks to contribute evidence that may support sustainable maternal workforce planning in PNG.
Global evidence demonstrates that shortages of skilled healthcare workers significantly affect maternal and neonatal outcomes, especially in low- and middle-income countries (Campbell & Graham, 2006).
The WHO identifies health workforce shortages as a major barrier to achieving universal health coverage and reducing maternal mortality (WHO, 2016). Studies have shown that the availability of skilled birth attendants is associated with improved maternal survival and reduced childbirth complications (UNFPA, 2021).
Research from rural and remote healthcare settings indicates that workforce retention is influenced by working conditions, professional support, accommodation, career advancement opportunities, incentives, and safety concerns (Lehmann, Dieleman, & Martineau, 2008).
According to Lehmann et al. (2008), rural retention strategies should include both financial and non-financial incentives to improve workforce stability in underserved areas.
In Papua New Guinea, maternal health indicators remain poor compared to neighboring Pacific countries. Rural communities continue to experience difficulties accessing skilled maternity services due to workforce shortages and geographic barriers (National Department of Health PNG, 2021).
Although healthcare workforce challenges in PNG have been discussed in policy reports, there remains limited empirical research focusing specifically on midwifery workforce planning and rural retention strategies.
This study therefore seeks to contribute evidence that may support sustainable maternal workforce planning in PNG.
9. Theoretical Framework
This study will use the WHO Health Systems Framework (WHO, 2010).
The framework identifies six key building blocks of a health system:
- service delivery,
- health workforce,
- information systems,
- medicines and technologies,
- financing,
- and leadership/governance.
The study will focus primarily on the health workforce component to examine workforce availability, deployment, retention, and policy support mechanisms.
This study will use the WHO Health Systems Framework (WHO, 2010).
The framework identifies six key building blocks of a health system:
- service delivery,
- health workforce,
- information systems,
- medicines and technologies,
- financing,
- and leadership/governance.
The study will focus primarily on the health workforce component to examine workforce availability, deployment, retention, and policy support mechanisms.
10. Methodology
10.1 Study Design
The study will adopt a mixed-methods research design combining quantitative and qualitative approaches.
Mixed-methods research is appropriate because it enables comprehensive understanding of workforce planning challenges by integrating statistical data with lived experiences of healthcare workers (Creswell & Plano Clark, 2018).
The study will adopt a mixed-methods research design combining quantitative and qualitative approaches.
Mixed-methods research is appropriate because it enables comprehensive understanding of workforce planning challenges by integrating statistical data with lived experiences of healthcare workers (Creswell & Plano Clark, 2018).
10.2 Study Setting
The study will be conducted in selected rural provinces of Papua New Guinea where maternal health workforce shortages are significant.
The study will be conducted in selected rural provinces of Papua New Guinea where maternal health workforce shortages are significant.
10.3 Study Population
Participants may include:
- nurse-midwives,
- rural healthcare workers,
- provincial health managers,
- maternal health coordinators,
- and policymakers.
Participants may include:
- nurse-midwives,
- rural healthcare workers,
- provincial health managers,
- maternal health coordinators,
- and policymakers.
10.4 Sampling Method
Purposive sampling will be used for interviews and focus groups, while surveys may use stratified sampling techniques.
Purposive sampling will be used for interviews and focus groups, while surveys may use stratified sampling techniques.
10.5 Data Collection Methods
Quantitative Data
- Structured questionnaires
- Workforce statistics
- Staffing records
- Structured questionnaires
- Workforce statistics
- Staffing records
Qualitative Data
- Semi-structured interviews
- Focus group discussions
- Policy document review
- Semi-structured interviews
- Focus group discussions
- Policy document review
10.6 Data Analysis
Quantitative Data
Data will be analyzed using descriptive and inferential statistics with statistical software such as SPSS.
Data will be analyzed using descriptive and inferential statistics with statistical software such as SPSS.
Qualitative Data
Thematic analysis will be used to identify key themes relating to workforce planning and retention.
Thematic analysis will be used to identify key themes relating to workforce planning and retention.
11. Ethical Considerations
Ethical approval will be obtained from relevant university ethics committees and Papua New Guinea health research authorities.
Participants will provide informed consent prior to participation. Confidentiality, privacy, and voluntary participation will be maintained throughout the study in accordance with international ethical research standards (Creswell & Plano Clark, 2018).
Ethical approval will be obtained from relevant university ethics committees and Papua New Guinea health research authorities.
Participants will provide informed consent prior to participation. Confidentiality, privacy, and voluntary participation will be maintained throughout the study in accordance with international ethical research standards (Creswell & Plano Clark, 2018).
12. Expected Outcomes
The study is expected to:
- identify major workforce planning gaps,
- propose rural retention strategies,
- improve policy recommendations,
- strengthen maternal healthcare delivery,
- and support long-term workforce sustainability in Papua New Guinea.
The findings may contribute to national maternal health policy development and workforce strengthening initiatives.
The study is expected to:
- identify major workforce planning gaps,
- propose rural retention strategies,
- improve policy recommendations,
- strengthen maternal healthcare delivery,
- and support long-term workforce sustainability in Papua New Guinea.
The findings may contribute to national maternal health policy development and workforce strengthening initiatives.
13. Proposed Timeline
Activity Duration Proposal development 3 months Ethics approval 2 months Data collection 6 months Data analysis 4 months Thesis writing 6 months Final submission 3 months
| Activity | Duration |
|---|---|
| Proposal development | 3 months |
| Ethics approval | 2 months |
| Data collection | 6 months |
| Data analysis | 4 months |
| Thesis writing | 6 months |
| Final submission | 3 months |
14. Budget Overview
Major budget areas may include:
- travel to rural provinces,
- accommodation,
- research assistants,
- printing and stationery,
- transcription services,
- and data analysis software.
These costs may be covered under fully funded PhD scholarships such as Australia Awards or RTP scholarships.
Major budget areas may include:
- travel to rural provinces,
- accommodation,
- research assistants,
- printing and stationery,
- transcription services,
- and data analysis software.
These costs may be covered under fully funded PhD scholarships such as Australia Awards or RTP scholarships.
15. Conclusion
Addressing shortages and retention challenges among nurse-midwives is critical for improving maternal healthcare services in Papua New Guinea. This study seeks to generate evidence that may support sustainable workforce planning strategies and contribute to improved maternal health outcomes in rural communities.
Effective workforce planning may strengthen access to skilled maternity care and support national efforts to reduce maternal mortality in PNG (WHO, 2016).
Addressing shortages and retention challenges among nurse-midwives is critical for improving maternal healthcare services in Papua New Guinea. This study seeks to generate evidence that may support sustainable workforce planning strategies and contribute to improved maternal health outcomes in rural communities.
Effective workforce planning may strengthen access to skilled maternity care and support national efforts to reduce maternal mortality in PNG (WHO, 2016).
References
Campbell, O. M., & Graham, W. J. (2006). Strategies for reducing maternal mortality: Getting on with what works. The Lancet, 368(9543), 1284–1299.
Creswell, J. W., & Plano Clark, V. L. (2018). Designing and conducting mixed methods research (3rd ed.). Sage Publications.
Lehmann, U., Dieleman, M., & Martineau, T. (2008). Staffing remote rural areas in middle- and low-income countries: A literature review of attraction and retention. BMC Health Services Research, 8(19), 1–10.
National Department of Health PNG. (2021). Papua New Guinea National Health Plan 2021–2030. Port Moresby: Government of Papua New Guinea.
United Nations Population Fund (UNFPA). (2021). State of the World’s Midwifery Report 2021. New York: UNFPA.
World Health Organization (WHO). (2010). Monitoring the building blocks of health systems: A handbook of indicators and their measurement strategies. Geneva: WHO.
World Health Organization (WHO). (2016). Global strategy on human resources for health: Workforce 2030. Geneva: WHO.
World Health Organization (WHO). (2021). Global strategic directions for nursing and midwifery 2021–2025. Geneva: WHO.
Campbell, O. M., & Graham, W. J. (2006). Strategies for reducing maternal mortality: Getting on with what works. The Lancet, 368(9543), 1284–1299.
Creswell, J. W., & Plano Clark, V. L. (2018). Designing and conducting mixed methods research (3rd ed.). Sage Publications.
Lehmann, U., Dieleman, M., & Martineau, T. (2008). Staffing remote rural areas in middle- and low-income countries: A literature review of attraction and retention. BMC Health Services Research, 8(19), 1–10.
National Department of Health PNG. (2021). Papua New Guinea National Health Plan 2021–2030. Port Moresby: Government of Papua New Guinea.
United Nations Population Fund (UNFPA). (2021). State of the World’s Midwifery Report 2021. New York: UNFPA.
World Health Organization (WHO). (2010). Monitoring the building blocks of health systems: A handbook of indicators and their measurement strategies. Geneva: WHO.
World Health Organization (WHO). (2016). Global strategy on human resources for health: Workforce 2030. Geneva: WHO.
World Health Organization (WHO). (2021). Global strategic directions for nursing and midwifery 2021–2025. Geneva: WHO.
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