This review outlines the main organizational, financing, human resources and service delivery features of the health-care system. Although there has been implement in overall health outcomes since the 1990’s the current levels are still below average for the country’s Pacific neighbors. The remoteness of the many rural communities has hampered improvements in health services. This is one of the major challenges that the country faces in order to achieve SDG heath targets by 2030. This Hits highlights steps taken to overcome challenges especially in the face of epidemiological change in disease burden that is slowly taking place in the country.
2. Health Systems in Transition:
Independent State of Papua New Guinea Health System
Review
2
Authors:
Technical editors:
Maxine Whittaker
Neville Smith
John Grundy
Paison Dakulala
Ken Wai
Anna Maalsen
Maxine Whittaker
Suggested citation: Grundy J, Dakulala P, Wai K, Maalsen A, Whittaker M. Papua New Guinea Health System
Review. Vol. 9 No. 1. New Delhi: World Health Organization, Regional Office for South-East Asia; 2019.
3. Context
Geographically challenging
Transport infrastructure limited
Epidemiological and
demographic transition
Predominantly young
Predominantly rural (80%)
Subsidence agriculture
Linguistic and cultural diversity
+++
Adult literacy 57%
Males>females
Primary school enrollments
low ( M 63% /F 57%) but
increasing
High levels of extreme poverty
Decentralized government
Lower middle income
Volatile economic growth
(boom and bust cycles)
Tight fiscal context for health
are financing
Tax revenue on 13.5% GDP
Significant role of Churches in
delivery of care
Predominantly patriarchal
Strong social support systems
(“wantoks”)
7. There is a persistent and strong spatial distribution
of disadvantage – (educational attainment, literacy
rates, malnutrition) in Papua New Guinea with the
poor areas showing relatively little change over 30
years.
Rogers et al 2011
7
8. Health system status
Inequities in access to and
low coverage of essential and
primary health care services
Higher levels of morbidity
and mortality especially
maternal and child health
Health infrastructure and
workforce gaps and
maldistribution
Health system responses
“Back to Basics”
Provincial health authorities
Free primary health care
policy
Scale up of health workforce
investments
Facility financing options
Planning –budget at sub-
national level nexus
31. Poor quality
drugs
Wrong drugs
Not enough
Not on time
Cannot
diagnose
and treat
effectively
Inefficient use of
human resources
and infrastructure
Lost of trust by
community
Loss of health
worker motivation
Inefficient use of
funding
34. Review discussions
90% annual NHIS monthly summary form submission/
timeliness issue/limited feedback
Standardized data items
Limited quality assessment of data
Focus on data for decision making required to guide
planning, implementation, coverage, supply chains
Capacity development agenda
Use of data for advocacy
Data linkages – across the sector, between sectors –
transparency, accountability, efficiency, health security.
“Underdeveloped” ICT for communications and data
analysis (NHP)
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64. In Summary
Complex coverage challenges. Unequal
coverage
Many “moving parts” to the health system and
its financing.
Health financing levels inadequate, funds flow
poor and “leakages”, efficiency of use
Policies and Plans provides platform to deliver,
resources and capacity issues negatively
impact implementation
Health workforce major gaps and time lags to
address. Major constraint
Major gaps in health system readiness
(supplies, staff , infrastructure and equipment)
Not just health sector – critically dependent
also on whole of government reforms
Back to
basics
65. Vision and Need: Universal coverage
of acceptable level of quality cost
effective primary care services
“Back to Basics” Approach is right option. To achieve and sustain
needs:
Investment in human resources development and
management
Health infrastructure
Improved provincial and district health management capacities
Timely availability of operational financing
Timely reliable medical products availability
Quality assurance of services e.g. supervision
Operational referral pathways defined and utilized
66. Integrated people centered primary
health care with universal coverage
https://www.deviantart.com/nigelgough/art/Pacific-Island-Village-546490340
http://www.ricardadas.com/2018/11/nos-hacemos-viejos-que-es-lo-importante.html
https://ncdak.wordpress.com/about/
https://nwmphn.org.au/about-nwmphn/primary-health-care-system/person-centred-medical-home/
https://www.philips.com.sg/healthcare/about/events-calendar/ismrm-2015
Affordable, Acceptable,
Accessible, Quality
67. Acknowledgement
This presentation was given by Professor Maxine Whittaker during the launch of
PNG HiT on 28th February 2019 at the Stanley Hotel, Port Moresby, Papua New
Guinea
68. Based on the Health Systems in Transition
The Independent State of Papua New Guinea Health System
Review, 2019
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