OBG talks to Pascoe Kase, Secretary of Health

Interview: Pascoe Kase

What will the implementation of universal health care mean for PNG’s citizens, and how do you anticipate introducing the changes to support it?

PASCOE KASE: The Department of Health welcomes the government’s initiative to introduce universal health care in PNG. It is good news for the many marginalised people who have had difficulties accessing basic health services in the past, especially those in remote areas. I would have preferred to have the system in place prior to announcing it to the public – meaning getting all the facilities operational with trained staff, adequate supplies of medicines and proper infrastructure. People are marching in expecting adequate services as we speak and this is a concern, as we know that the process will take at least a year, but as a public service body it is our responsibility to respond to the government’s call.

For years there have been talks of introducing universal health care in PNG and I am glad that it was finally done. Inevitably this policy announcement met with a certain level of criticism, but let us not forget that PNG has the highest maternal and child mortality rate in the West Pacific. Mothers in rural areas risk their lives delivering babies at home and 250 of them die for every 100,000 live births according to a 2008 study.

Public hospitals claim they charged patients to keep facilities running, as budget allotments were not delivered. How do you respond to this argument?

KASE: In most cases funds were delivered to provincial treasurers, but admittedly monitoring the expenditure has been one of our major weaknesses. While patients’ fees were introduced to overcome this issue, hospitals could only charge 7% of their requirements, so at the end of the day it didn’t really have a major impact on finances, but it did stop a lot of people from accessing health care facilities. The commitment of the government is to cover in full this expense and it has allocated as much as PGK9m ($3.65m) to provincial government facilities, PGK6m ($2.4m) to rural health services provided by provincial government, and PGK5m ($2m) to church health services. This is actually more than they collected on a yearly basis by charging fees.

How is the government coping with higher patient visits, up 30% since the policy was announced?

KASE: The announcement of universal health care is a call to the nation, and everyone will have to pull out extra resources to make it happen. It is the right of every citizen to access the government’s free health care facilities and it is the hospital’s duty to provide services. All the mismanagement that we have seen in the past has no reason to exist under the current arrangement and, even if there will be shortcomings in the process, there is no turning back at this point. For the last three years the government has allocated larger budgets to health care, so it is a question of how to use funds and ensure they are delivered on time.

What would you say are the priorities in the PNG health sector at the moment?

KASE: Medical equipment in PNG has fallen below reasonable standards over the years and a certain level of infrastructure rehabilitation is taking place at the moment to achieve better standards. We are also opening new community health posts; however, the biggest problem that we are facing is a lack of capacity. The government has approved a Human Resource Enhancement Act to tackle this issue and that includes bringing professionals from overseas when necessary, even though it has met resistance among certain segments of our society. One of the biggest issues in this country is the accommodation of nationals, so we strongly suggest that the government build proper housing for PNG’s nurses as well as foreigners, to quench this debate. Greater integration between hospitals and rural health services is also essential in order to ensure that doctors are visiting rural areas and not only urban centres. For this reason the Provincial Health Authority Act was passed in 2007 and seven provincial governments are currently implementing it with excellent results.