Health sector struggles as Papua New Guinea's population grows

A diverse population and rugged terrain present unique challenges to providing effective health services in Papua New Guinea, especially in rural areas. Growing at an estimated annual rate of 3.1%, PNG’s population is a youthful one, with 38% younger than 15 years and only 5% over 60. The fertility rate of 3.8 live births per woman contrasts with an infant mortality rate of 47.6 deaths per 1000 live births. Those born in 2012 could expect to live 62 years, compared to 76 in the region and 66 for its income group, according to the World Health Organisation (WHO).

Funding & Structure

The central government allocates public funds for services through hospitals, health centres, aid posts and dispensaries, and also runs Port Moresby General Hospital, the country’s major teaching and referral unit, as well as specialist, regional and provincial public hospitals. Provincial health authorities (PHAs) are charged with providing health services to rural areas, in the form of aid posts, community health posts, hospitals and health centres, for which they receive earmarked grants. Health services are also available at church-run health centres – which supply about half of all rural health services – as well as at aid posts operated by community health workers and a host of domestic and international NGOs. The Department of Health (DoH) also partners with a number of non-state providers of health services. In many cases these carers receive government funds to carry out their work.

The National Health Services Standards (NHSS) defines minimum standards for health facility infrastructure, staffing levels and standard equipment lists. The NHSS also sets the standards for an accreditation system for hospitals and health centres. PNG relies heavily on pharmaceutical imports from nearby more developed countries, with much of these imported from Australia. The medical supplies branch of the National Department of Health registers all pharmaceutical products brought into the country.

Mental health services are provided under the Mental Disorders and Treatment Act of 1960. PNG had 0.3 mental health outpatient facilities and 1.2 beds in psychiatric hospitals per 100,000 people in 2011. These shortages are exacerbated by a dearth of psychiatric professionals and the lack of a formal centralised data collection system for mental disorders. As a result, the incidence and types of mental disorders are largely unknown. However, data included in the National Health Plan indicated that in 2008, 0.14 per 100,000 deaths were related to mental health conditions, or 0.13% of the total deaths in PNG.

As a result of the high level of gender inequality in PNG society, gender-based violence (GBV) is a major and widespread threat. About 67% of PNG women experience some form of GBV. Such violence can have disastrous effects on women’s mental health. Despite this, mental health services are not equipped to support women suffering from GBV.

Prioritising Basic Health

The NHP 2011-20 emphasises the provision of basic health care for poor and rural citizens, with the key aim of providing universal health coverage and equal access to health care for poor citizens. It also aims to enhance integration between hospitals and rural health services and calls for the construction of new hospitals.

The DoH creates and administers health policy at the national level, while day-to-day management of the NHP is entrusted to the provincial, district and local-level governments. The NHP supports the PNG Development Strategic Plan 2010-30, as well as the goals of PNG’s Vison 2050. One goal is to be among the top 50 countries in the UN Human Development Index (HDI) by 2050. This looks unlikely however, as PNG did not achieve any of WHO’s Millennium Development Goals and its HDI value for 2014 was 0.505, as charted in the UN Development Programme’s 2015 Human Development Report. At 158 out of 188 countries, this value places PNG in the “low human development” category, close to Solomon Islands and Laos, with HDIs of 156 and 141, respectively.

Urban vs Rural

Rates of both communicable and non-communicable diseases are on the rise in the country. These include diseases commonly seen in developing countries such as HIV/AIDS, malaria, tuberculosis, leprosy and cholera, as well as developed-country illnesses like cancer, heart disease, obesity, diabetes and hypertension. This combination of health issues complicates the accurate targeting of care to the correct population and region. HIV/AIDS, tuberculosis, malaria and acute respiratory infections caused the most deaths for both men and women in 2012, the most recent statistics available.

Of PNG’s urban population, about 310,000 live in the capital, Port Moresby, where the most modern health services are located. Yet about 85% of the entire population – estimated at 7.4m in 2014 – live in rural areas, according to Australian Doctors International. Indeed, PNG has fewer than 400 doctors countrywide, of whom only 51 work outside Port Moresby. In theory, there is one doctor per 17,068 people, but in reality large numbers of Papua New Guineans lack any access to modern medical care.

The 2015 Sector Performance Annual Report (SPAR), a tool for NHP administrators to measure progress against targets, showed positive outcomes in the areas of PHAs, medical supplies and major public health programmes, including the incidence of malaria. Between 2011 and 2015, the number of malaria cases halved, from 205 to 102 per 1000 population, according to the 2015 SPAR. However, the report also found the number of outreach clinics and aid posts had declined compared to 2005. The number of supervision visits also decreased significantly over the decade, contributing to poor access to and deteriorating quality of health services in rural areas.

Facilities

A number of private health facilities provide inpatient and outpatient medical and diagnostic services. These include three large private hospitals, all in Port Moresby: Pacific International Hospital, the Aspen Medical Harbour City and Paradise Private Hospital, the country’s first private hospital.

Church health services perform a key role in the health system in rural PNG. The main administrative body representing faith-based care is the Christian Health Services (CHS). CHS is an influential organisation, particularly in rural areas, where churches provide the bulk of health services. Indeed, churches run most of PNG’s nursing schools and health training schools, as well as aid posts and clinics.

Funding

The government spent 4.3% of its GDP on health care, or $109 per capita in 2014, according to the WHO. Approximately 20% of health sector spending comes from donors, with Australia contributing the largest portion. In 2015-16, 20% of Australia’s total $408.4m Overseas Development Aid (ODA) to PNG went towards health-related investments.

The Health Sector Improvement Programme (HSIP) manages and coordinates these donor funds via the HSIP Trust Account, which combines funding from donors, government and global initiatives. Health-sector reviews are conducted by the Independent Annual Sector Review Group, while cooperation between the PNG government and non-governmental health service providers is overseen by a partnership policy. A free primary health care programme was launched by the national government in 2014. With the aim of making basic health care free for all Papua New Guineans, it eliminated user fees from medical centres and clinics.

In response to the collapse of global commodity prices, the government has imposed austerity measures, including budget cuts of 40% across the health system. This triggered a series of doctor strikes, “sickouts” and “go-slows” in mid-2016. Yet the president of the National Doctor’s Association (NDA), James Naipao, stressed that those refusing to work did so not officially but as individual acts of “civil disobedience”. While the health care situation is in flux, a dire need clearly exists for private firms to join NGOs and state ODA funding to boost health investment of all kinds.