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.

1. Health Systems in Transition
Papua New Guinea
Health System Review

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”)

6. Health, transport,
infrastructure
hardest hit in cuts
Development assistance role to “buffer”/Boost

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

11. 64/1000

15. Leadership and Governance

22. Financing

24. $86 US

25. 25

29. Access to Essential Medicine and
Commodities

30. https://www.who.int/medicines/areas/access/supply/en/

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

32. Health Information System

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)
34

35. Health Workforce

38. WHO 2016 analysis:
< 2.28 physicians, nurses,
midwives/1000 people –
fail to meet 80% target
immunization and skilled
birth attendance
PNG 2010:
0.587 physicians,
nurses, midwives
/1000 population

43. Service Delivery: Models of Care and
Infrastructure

49. National Health Plan:
Key Result Areas

51. Immunization Coverage

52. Success factors: Malaria Program
NDoH 2013 d

53. Success factors for service utilization
Sector Review Carmichael et al 2015

56. Access
National Health Plan 2010

57. Coverage

59. Quality and Safety
https://nursing.vcu.edu/
Limited information

61. Responsiveness

62. Social and Financial Risk Protection
https://www.who.int/health_financing/policy-framework/en/

63. Improved Efficiency: Allocative
Efficiency and Technical Efficiency
Proposed Approaches NHP and NH Service Standards
( 2011)

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
68

69. http://www.searo.who.int/entity/asia_pacific_observatory/publications/hits/hit_PNG/en/
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