Implementation of evidence-based healthcare in Papua New Guinea.

AIM: The aim of this research was to understand how health workers in developing countries reach diagnostic and treatment decisions. In developing countries, health workers are often forced to make diagnostic and treatment decisions based on limited knowledge, unhelpful information, infrequent and low technology back-up services and without the support of more senior staff. Yet patients continue to be treated. This paper investigates how primary healthcare workers in such contexts reach these diagnostic and treatment decisions.
METHOD: Using a qualitative methodology, 58 primary healthcare workers from the three primary healthcare facilities in Papua New Guinea--aid posts, sub-health centres and health centres--participated in an in-depth interview, in order to investigate how diagnostic and treatment decisions were made.
RESULTS: Although participants were originally trained in the biomedical model, they lived and worked in a context where other belief systems operated to diagnose and treat illness. This led to the coexistence of at least three models of treatment: the biomedical model, traditional indigenous health practices and Christian beliefs. Thus, a homogenous biomedical understanding of health and well-being was not possible in this setting, and treatment options did not always follow the biomedical recommendations.
CONCLUSIONS: In developing countries where competing medical frame works exist, evidence-based practices may be more difficult to implement. Although the skill and knowledge of the provider and availability of treatment resources are still important, belief in the accuracy of the diagnosis and the potency of the treatment by the patient and the patient's community as well as the health provider may be just as significant.