OBG talks to Grant Muddle, CEO, Port Moresby General Hospital

Interview: Grant Muddle

How could the proposal for turning Port Moresby General Hospital into a statutory body help improve health services in Papua New Guinea?

GRANT MUDDLE: Turning the hospital into a statutory body, which essentially gives you full control over the budget and the way it is spent, will cut a lot of the red tape currently present in the system. This sort of financial independence doesn’t mean that a hospital won’t have to obey the Public Finance Management Act or the Public Hospital Act anymore, but on paper it will allow top managers to implement programmes in a timely fashion following the board’s decisions. At the moment, the procurement process goes through three different levels of authority, which slows down the process considerably and is not aligned with the government’s long-term vision of bringing the country’s health sector up to international standards. Awarding statutory body status to Port Moresby General Hospital will be a mini-revolution for the health sector in PNG. When the change is successfully implemented, it will serve as a model to be replicated in other parts of the country.

Why has the health sector fallen below international standards?

MUDDLE: I do not think it would be constructive to identify the historical reasons why this has happened, but it would be best to concentrate on the solutions instead. What seems clear is that funds were rarely lacking in the past, so perhaps the problem was the way in which they were utilised. I think that what the sector needs is better accountability and transparency in the future and not to repeat the same mistakes. This administration seems to be seriously committed to overhauling the health sector, and that is a good place to start. We have to embrace change.

How successful has the universal health care system been since it was introduced?

MUDDLE: I think that there is a certain level of misunderstanding among the general public concerning the purposes of the free and subsidised health policy introduced in February 2014. Here at Port Moresby General Hospital, which is a tertiary referral hospital, we have seen an influx of patients turning up without appointments. This puts us in an uncomfortable position, as it is hard for us to explain to all of them that our trained specialists can only see a limited number of patients per day, and only after they have been referred by a general practitioner. This is not a unique model; it also exists in other countries such as Australia. Unless it is a real emergency, unfortunately we are forced to turn away a lot of these patients.

Anybody can turn up at our emergency department, of course, but they will get medical attention on a requirement-of-care basis, not on a first-come first-served basis. So if a patient has a splinter, he or she may have to wait several hours or days before being treated, as more serious cases will inevitably take priority. Going forward, we need to improve our communications to educate the general public about which services they can expect health facilities to provide.

What immediate measures could be introduced to streamline the current system?

MUDDLE: A hospital information management system would go a long way in PNG, as everything is still manual when it comes to medical records, appointments, scheduling and other procedures. Introducing a computerised system will also be instrumental in building a national medical record, so that patients’ histories are easily accessible through biometric indicators like fingerprints, for example. With that information at hand, a general practitioner can then refer patients to specialists within the hospital system and even schedule an appointment, as all the necessary information will be available online. We are currently looking at open source solutions, which are used in hospitals worldwide, from the US to Rwanda, a country that has similar infrastructure development needs to PNG. We are aiming to find a system that will work in our environment.