Maternal and newborn health services in Papua New Guinea: Health system stakeholder priorities for health system strengthening

Papua New Guinea (PNG) has one of the highest maternal and newborn morbidity and mortality rates in the Asia-Pacific region, with the COVID-19 pandemic exposing longstanding system weaknesses. This study examines established health system gaps affecting maternal and newborn health (MNH) outcomes in PNG, identifies those considered both high-priority and feasible to address by local stakeholders, and highlights locally driven solutions for sustainable improvements. Qualitative data were collected using card-sorting, with analysis guided by the AAAQ framework (Availability, Accessibility, Acceptability and Quality). Priority gaps identified as both significant and feasible to address included shortages of health facilities and workforce, difficult physical access to services, limited patient-provider communication, mixed feeding, disrespectful maternity care, inadequate supplies, limited training and technical support for MNH workers, poor infrastructure, unclear role of men in maternity care, limited funding and leadership gaps. COVID-19 further revealed an absence of a well-defined emergency response plan. Participants recommended investing across all four AAAQ domains through scaling up proven local initiatives, such as waiting houses, strengthening the grassroots workforce and leveraging innovations, including telemedicine. Building a resilient MNH response in PNG requires strong local leadership to determine local priorities, invest in health information systems and a gradual shift towards domestic funding.