National Health Plan 2011 - 2020

1.00 Non-communicable diseases (for example, 0.00 cardiovascular disease, diabetes, chronic respiratory illness and renal disease) occur, but in small numbers to 2003 2004 2005 2006 2007 date. Obesity is oen considered a sign of wealth, and is likely to link to excessive consumpon of Western foods rather than tradional foods. It is expected over the coming decade that non-communicable diseases Malaria remains an intractable problem in PNG, and will become more prevalent as a result of urbanisaon, is the second most common cause of admission to greater penetraon of energy-rich Western foods hospital. It aects all age groups, but is most lethal in and market goods to rural areas, increasing wealth in children, and with serious consequences in pregnancy. sub-sectors of the community, and a shi away from There are some signs of hope. The malaria program tradional lifestyles and tradional foods. Current has received more funds and the incidence of malaria hospital data does not yet show evidence of this. has steadily declined in the past ten years. Further Cancer rates have remained the same over the past ten gains can be expected with recent prevenon and new years. However, there is lile capacity for diagnosing treatment programs. Malaria and acute respiratory cancers, which may cause under-esmaon. There are tract infecons (in parcular, pneumonia), are the two now more people living beyond the age of 65, which leading diseases in PNG. leads to the likelihood of increasing burden of cancers Tuberculosis is again of increasing concern. With in PNG. the excepon of obstetric cases, tuberculosis now Dependable clean water sources and lack of access to consumes 13% of hospital bed days, more than any toilets, parcularly in rural areas, creates a situaon other illness. These concerns are further fuelled by where diarrhoea and other enteric diseases may increasing evidence of mul-drug resistance and easily spread. Diarrhoea features as one of the leading the co-existence of HIV, as well as worrying levels of reasons for both inpaent and outpaent visits to people defaulng from treatment programs. health facilies. This burden is further compounded by The past decade has seen the rapid disseminaon the risk of epidemic illness. The emergence of cholera of HIV throughout the country, reaching into every in 2009, not seen in the country for nearly 50 years, is 12 | Government of Papua New Guinea Chapter 3 State of Our Health Volume 1 | Policies and Strategies indicave of the risks that exist when safe water and Access to services is frequently extraordinarily dicult. sanitaon are not available and basic hygiene, such as Nearly a third of all aid posts are closed. Retrieval hand-washing, is neglected. systems in emergency situaons are limited. Most villages lack any capacity for telecommunicaons. The Many of the deaths and illnesses in the country can be rate of unsupervised births at home is more than four prevented by having safe water and proper sanitaon, mes those of urban births; immunisaon coverage is proper hygiene pracces, and balanced nutrion. lower in rural areas. Child mortality in rural populaons Improving access to health services, and ensuring the is double that of urban children. Diarrhoeal disease and system has the resources, such as medicines, well- acute respiratory infecons occur at higher incidence. performing sta and communicaon systems, are all well established as eecve ways of improving health. The PNG populaon is expected to double in the next twenty years, increasing the demand upon health Determinants of Health services. Regional dierences in health are large. Frequently, ill health is directly or indirectly a result The recent DHS shows that the Momase and Highlands of the physical environment (e.g. nutrion, safe regions are most disadvantaged in health status (and water, and proper houses); the social and economic in access of health services). Incidence of fever and environment; and also educaon and behavioural acute respiratory infecons are the highest. Deaths of choices (e.g. smoking, sexual behaviour, diet and children under the age of 5 years are twice as common physical acvity). In addressing health concerns, these in the Highlands than in Southern Region, relave to ‘determinants’ must be considered to target strategies the populaon (see Figure 13). appropriately. Figure 13 Childhood Mortality Distribution Physical environment and urbanisation Poor quality water and unhygienic or non-existent toilets (where animals, insects, or people can spread Early Childhood Mortality Rates infecon through contact with human faeces) increase 100 Deaths/1,000 Live Births the risk of gastro-intesnal illness. Surveys of villages 80 and urban centres conrm that a large proporon 60 of the populaon face these risks. Only 46% of rural 40 households have access to a clean water source. As 20 much as 18% of the rural populaon and 5% of the 0 urban populaon have no access to a hygienic toilet. n ra so ut hi her ba ru l gh n m ndsla om ur no a isl se an ds Crowding in households not only places pressure ed uc gr ao ad nes gr 1–5 ad gr es 6 ad es 7+ upon household facilies, but increases the likelihood NNMR IMR U5MR of transmission of infecon, including skin, gastro- intesnal, and respiratory contagion (including skin diseases, diarrhoea, pneumonia, tuberculosis, and others). Every fourth urban household has nine or more persons living in it, with 5% of urban households having Education relates to better health seven or more persons sleeping in one room. This Beer health is strongly correlated with educaon, level of crowding in urban households has increased especially of girls and women. Those with educaon by 20% to 40% over the past decade. Psycho-social are more likely to access health informaon through concerns arise with urban migraon, due to limited mass media, to access health services, and to give opportunies and separaon from family and cultural birth to their children in a health facility. Childhood sengs; there is also an increased risk of trauma and mortality rates fall in direct relaonship with greater violence-related injury. levels of educaon. More years of educaon of girls results in having the rst child later and correlates Geographical location and access to health with improved spacing between children, which in services turn results in improved health of the mother and the children. Higher educaon levels are also linked The majority (87%) of PNG’s populaon, however, to greater knowledge of methods and sources of live in rural sengs. A lack of quality water and poor family planning, and with improved care of infants and sanitaon facilies lead to gastro-intesnal illness, children. among the ve most frequent illnesses in PNG. Chapter 3 State of Our Health Government of Papua New Guinea | 13 Naonal Health Plan 2011 2020 Social and cultural transion in some parts of the While the Act does not fundamentally change the society, including shi from subsistence to cash responsibilies and accountabilies of each level of economy, changes in tradional values and norms, government, it does enhance the ability of government and deterioraon of social safety nets, connue to to direct nance to priority areas for health service contribute to health concerns, including common delivery. sexually transmied infecons and violence. The age of rst intercourse for men, for example, has decreased Access to Health Services by 2 years over the past 25 years. At the commencement of the current plan, 78% of Gender plays an important role in health choices registered aid posts were open. Aer almost nine and health outcomes, as well as age, with programs years this has deteriorated to 71%. This equates to 781 needing to target in accordance with sex and age- more aid posts closed during the implementaon of specic risks. More health informaon broken down the current Naonal Health Plan 2001–2010. by sex is essenally needed. From 2003 to 2008 the general inpaent bed numbers Personal choice — of diet, physical acvity, smoking decreased by 1,328. The naonal trend on the number and drinking — all in uence health. There is very of outpaent visits per person to health centres (not limited informaon available to quanfy these risks aid posts) over the past ve years has also gradually in PNG. Nutrion is beer known than the others: declined. Outreach clinics from health centres to rural every third man suers from anaemia resulng in remote villages, to provide essenal immunisaon, lower producvity. Nutrion of children has improved nutrion monitoring, antenatal care, and family in the past years. Smoking seems to be increasing planning, have stalled from an already unacceptably as more cigarees are brought across the border low level. from Indonesia. Betel nut chewing with lime is very common, causing oral diseases including cancer. Figure 14 Outreach Visits Health System Performance Naonal Trend — Outreach Clinics Held For Every Health Sector Reform — Provincial Health 1,000 Children Under 5 Years Authorities 30 Over the past decade, successive governments have 25 commied to implemenng reform iniaves to 20 enable the health sector to reverse the decline in 15 service delivery and health indicators. In 2007 the 10 Parliament of PNG passed the Provincial Health 5 Authories Act. This landmark amendment enables streamlining of provincial health services to occur 0 by transferring the management of public hospital 2004 2005 2006 2007 2008 services and rural health services to one Provincial Health Authority or enty. The Act creates the right for provinces to choose to create a single Provincial Health Authority responsible Performance of Medical Supplies for the management of health service delivery within Procurement and distribuon of medical supplies the Province. This will occur when the Minister and and vaccines to health facilies in PNG remains a the Provincial Governor agree that provincial health major challenge for the health sector. The evidence services may be beer delivered under a unied system shows that there is a consistent low availability of key and they enter into a provincial health partnership medicines. agreement. Three provinces, Milne Bay, Eastern In 2004, 40% Health Centre kits were introduced to Highlands, and Western Highlands, signed in 2009 supplement the roune supply chain. However, this to pilot the implementaon of the Provincial Health has not improved the situaon, with ‘stock outs’ of Authority. Several other provinces also indicated key medicines (see Figure 15) increasing. Key reforms their intenon to implement these reforms. In 2011 in the medical supply area to improve procurement a review of the outcomes of the pilot is expected, and distribuon networks have not gained signicant and acceleraon of the roll-out of the PHA to other tracon. provinces. 14 | Government of Papua New Guinea Chapter 3 State of Our Health Volume 1 | Policies and Strategies Provincial transit stores lack adequate facilies and According to the Asia Pacic Alliance for Human space to store and distribute medicines and vaccines. Resources for Health 2008, PNG has a rao of 0.58 Poor storage facilies at rural health centres and aid health workers (doctors, nurses, and midwives) per posts are a major concern for safe keeping of drugs, 1,000 populaon (2000 data), compared with Fiji at vaccines, and intravenous uids. Health managers lack 2.23, and 2.74 for Samoa. skills in management of drugs and supplies. The and Combined with the declining state of health facilies illegal sale of medical supplies is common. and the inability of health services to meet the needs of the populaon, these factors have had a signicant Figure 15 Medical Supplies at Facilities negave eect on the morale of health workers. Naonal Trend — % Health Facilies Adequately Stocked As well as the limited numbers of available health with Essenal Medicines workers, those trained in specialist clinical and technical skills are not located where they are supposed to be. 60 For example, the recent proles produced by NDOH 58 HR branch indicated that over 30% of skilled health 56 professionals were occupying administrave and 54 management jobs. 52 48 46 Performance of Expenditure in Health 44 Chronic under-funding of health systems limits the 2004 2005 2006 2007 2008 capacity of the health sector to provide adequate services that are of acceptable quality. The World Health Organizaon (WHO) recommends that for a developing country to provide a basic package of Figure 16 Ageing Workforce essenal health services it must spend at least US$34 per capita per annum. According to the WHO (reports Current Workforce Age Bracket 2006, 2007, 2008, and 2009) government per capita 70 expenditure in Papua New Guinea during the same 60 period from 2000 and 2006 ranged between US$21 50 and US$24, peaking at US$34 in 2005. As an example 40 during the same period, Fiji spent an average of US$94 30 per capita, peaking at US$148 in 2005. As a proporon 20 of total government expenditures, PNG spent an 10 average of 9.5% on health, with an average of 3.7% of 0 CHW Nursing HEO MO Support Allied GDP during the same period. Officer Staff Health Naonal Economic and Fiscal Commission (NEFC) < 50 Years > 50 Years No Data studies also indicate that while there is some improvement in funding for health, it remains the lowest-funded sector in meeng the government’s Performance of Human Resources Medium Term Development Strategy (MTDS). However, there is some hope for the future with the Increasing populaon growth, impacts of new GoPNG indicang in the recently released Vision 2050 and emerging diseases, and changing paerns of document that 20% of the development budget will be behaviour leading to more lifestyle-related illness, given to health in the near future. connue to outpace the human resource capacity of the health sector to respond eecvely to the needs Overall government per capita expenditure on health of the people. in PNG fell way below the recommended US$34. There are challenges in the eciency of health spending in A picture emerged at the 2008 Human Resources (HR) terms of both allocaon (doing the right things) and Forum of an ageing workforce, low on crical cadres technical (doing things right) eciency. This situaon such as midwives and community health workers, with is compounded by inadequate available resources, low wages and insucient capacity within training especially at the provincial level. facilies to produce the number of health workers needed. Chapter 3 State of Our Health Government of Papua New Guinea | 15 Naonal Health Plan 2011 2020 Figure 17 Expenditure — International Comparison Papua New Guinea 2000 2003 2004 2005 2006 Government expenditures on health as % of total government 9.9 10.9 10.0 9.6 7.3 expenditures Government health expenditures as a % of GDP 4.0 3.4 3.6 4.2 3.2 Government per capita expenditures on health (average exchange 21 20 26 34 24 rate US$) Fiji 2000 2003 2004 2005 2006 Government expenditures on health as % of total government 10.3 7.8 9.1 9.6 8.4 expenditures Government health expenditures as a % of GDP 4.7 3.7 4.6 4.1 3.7 Government per capita expenditures on health (average exchange 68 64 92 148 97 rate US$) Sources: WHO Stascs Reports (2006, 2007, 2008, and 2009). The Sector-wide Approach (SWAp) Informaon System (an acute care focused paent Since the introducon of the Health Sector level data collecon). Improvement Program (HSIP) in November 2004, The geography of PNG makes it suscepble to further concerns have been expressed about a number of major health risks. While there has been development aspects of the SWAp, including weak absorpve of communicaon systems to all health facilies capacity, and the diculty of geng resources to throughout the country during the past decade, provinces and districts, thereby resulng in limited or nocaon of and capacity to respond to disease no improvement in the health indicators. outbreaks remains very limited. During 2010 the review of the current health SWAp arrangements is being undertaken. Through this Addressing the Concerns consultave process between key stakeholders The current situaon cannot remain. There is an in the health sector, it is proposed to develop/ urgent need to address priority health problems, recommend possible adjustments of the health SWAp and to ensure that quality services can carry these arrangements. programs to the villages, health centres, and hospitals throughout the country. The problems of service Information Communication Technology provision will be exacerbated by growing populaon With one excepon, PNG has an extremely pressure. The transional economy, with its potenal underdeveloped Health ICT infrastructure; the for greater access to cash by Papua New Guinea excepon is the PNG health radio network linking cizens, is likely to lead to a ‘double burden’ health around 1,300 facilies across the country. prole, with persistence of communicable diseases as the dominant health problem, yet a growing burden This is one of the largest such radio networks in the from non-communicable diseases. This will further world. Apart from this network there is lile or no ICT challenge the health system. connecvity between provinces and Port Moresby, within provinces, or even within hospitals and provincial health oces. This is in an environment of a very good, though expensive, telephone system and mobile telephone systems that already have wide coverage and are steadily increasing in coverage and reducing costs to the users. Aside from the nance and payroll systems, the main naonal system is the well-established Naonal Health Informaon System (essenally a primary care informaon system), and the naonal Discharge 16 | Government of Papua New Guinea Chapter 3 State of Our Health Volume 1 | Policies and Strategies Chapter 4 The Way Forward The Vision 2050 of the Government of PNG describes Priority areas for investment across all sectors, the where we see ourselves as a naon in the next forty minimum suite of health services that must be years — ‘We will be a Smart, Wise, Fair, Healthy provided by each level of government, and new and Happy Society by 2050’. The PNG Development areas of reform, are all arculated within this Plan to Strategic Plan (PNG DSP) 2010–2030, developed by ensure the eorts of all players combine to reverse the the Department of Naonal Planning and Monitoring deteriorang health indicators in the country. Growing (DNPM), is linked to and guided by the Naonal Vision a healthy naon requires the eorts of everyone. 2050. Together these two documents challenge the health sector to transform itself and deliver quality Considering the current state of health in our naon, services to all people of PNG, by using innovave and the Goal of this Naonal Health Plan is to strengthen creave approaches and striving for internaonal best primary health care for all, and to improve service pracce. delivery to the rural majority and urban disadvantaged. In response, the health sector has draed a The priority strategy of the plan is ‘back to basics’, comprehensive and arguably ambious forty-year with rehabilitaon of the foundaons of our primary strategy — Health Vision 2050. This Naonal Health health care system, focusing on improving maternal Plan 2011–2020 is the rst of four ten-year plans health and child survival, and reducing the burden of designed to achieve Health Vision 2050. It outlines the communicable diseases. This will be enhanced through aim of a transformed health care system, delivering the implementaon of the Provincial Health Authority improved health for all Papua New Guineans, reforms, which are expected to roll-out across the while connuing to stand for the Human Face of country over the next ten years. Development. Concentrang our eorts on this goal, will lead to the The Naonal Health Plan 2011–2020 is the single realisaon of our Vision of a healthy and prosperous governing policy document for the health sector, from naon that upholds human rights and our Chrisan which all players — both private and public, both within and tradional values, and ensures: the health sector and in other supporng spheres of life in Papua New Guinea — take their direcon. Affordable, accessible, equitable, and quality health services for all citizens. Chapter 4 The Way Foward Government of Papua New Guinea | 17 Naonal Health Plan 2011 2020 National Health Plan 2011–2020 Our Vision A healthy and prosperous naon that upholds human rights and our Chrisan and tradional values, and ensures: Aordable, accessible, equitable, and quality health services for all cizens. Our Goal Strengthened primary health care for all, and improved service delivery for the rural majority and urban disadvantaged. Our Mission Improve, transform, and provide quality health services through innovave approaches supporng primary health care and health system development, and good governance at all levels. Health is Everybody’s Business 18 | Government of Papua New Guinea Chapter 4 The Way Foward Volume 1 | Policies and Strategies Within the ten years of this NHP, signicant progress • Quality: Pursuing innovave, high quality, and safe has to be made towards realising the Vision. All outcomes in all facets of our acvies and services. partners and actors in the health sector must share • Diversity: Acknowledging the diverse nature of the the same Mission to: Improve, transform, and provide country and the unique make-up of each seng. quality health services through innovave approaches supporng primary health care and health system • Teamwork: Working in partnership at all levels of development, and good governance at all levels. the health system with all stakeholders. Essential Values of the Health System Priorities for the First Ten Years • Accountability: Being accountable to the people This Plan has been developed in consultaon with for the services we deliver, and being commied relevant stakeholders and seeks to be realisc, to learning from experience to improve our aordable, based on the evidence available to us, performance. and, most importantly, a praccal and usable Plan. • People focused: Being genuinely concerned that The policy direcons for the immediate ten years our people receive quality health care and social from 2011 to 2020 are centred on rehabilitang the welfare services, respecng the dignity of all system we currently have to a level where each facility people, and delivering services in accordance with is fully operaonal, and on improving the ability that our cultural values and tradions. individuals have to take responsibility for their own health. This will require a three-pronged approach: • Integrity: Comming ourselves to the highest ethical standards in all that we do, and advocang • Targeted investment in improving service delivery to and applying best pracces to the best of our people living in the rural areas and in disadvantaged abilies. urban sengs, including the roll-out of the Provincial Health Authority reforms. • Equity: Striving for an equitable health care that is independent from polical decision making, and • Reinforcing health services with strong ecient being fair in all our dealings, irrespecve of age, systems for the health workforce, nancing, gender, ethnicity, religion, and polical aliaon. informaon, medical supplies, leadership, and governance. Figure 18 Focus Areas of National Health Plan 2011–2020 Chapter 4 The Way Foward Government of Papua New Guinea | 19 Naonal Health Plan 2011 2020 • Renewed dedicaon to reversing the trend of our • Strengthen Health Systems health indicators. To this eect, a series of priorised • Improve Child Survival health outcomes have been agreed for primary aenon, based on those diseases and situaons • Improve Maternal Health that have caused the greatest levels of morbidity and mortality over the previous ten years, as well • Reduce the Burden of Communicable Diseases as on areas that are likely to become threats to the • Promote Healthy Lifestyles health of our populaon. • Improve our Preparedness for Disease Outbreaks In summary, if we improve service delivery and address and Emerging Populaon Health Issues. priority health outcomes and strengthen health systems, we will achieve a healthy and prosperous These are outlined along with the accompanying naonal for all, both now and for future generaons. objecves and strategies in the following pages. The objecves concern all of the levels of health care, and all of those involved. All players should develop their Specic Objectives and Strategies specic plans to achieve these objecves. To achieve the vision, mission, and goal of the Naonal Health Plan 2011–2020, the sector will focus on the The list of strategies is not exclusive. Some of the following Key Result Areas: specic strategies require acon at the naonal level, while some are the responsibility of provincial, district, • Improve Service Delivery or facility level and should be transferred into acvies • Strengthen Partnership and Coordinaon with in the respecve plans. The relevant indicators and Stakeholders targets for each Key Result Area are discussed in Chapter 8 Performance Monitoring Framework. 20 | Government of Papua New Guinea Chapter 4 The Way Foward Volume 1 | Policies and Strategies Objective 1.2 Key Result Area 1: Improve Service Delivery Rehabilitated and strengthened primary health care infrastructure and equipment. Strategies

1.2.1 Increase the number of ward areas with at least one aid post open and available to deliver services.

1.2.2 Priorise rehabilitaon of aid posts, health centres, and district hospitals.

1.2.3 Increase the number of facilies in rural areas and urban selements that have essenal equipment available in accordance with the Naonal Health Standards, including funconing cold chain, communicaons, and transport.

1.2.4 Gradually rehabilitate essenal stac plant equipment at district hospitals and health centres, as per Naonal Health Standards. Objective 1.3 The right health professionals work in the right places, are movated, and deliver right (quality) services. Objective 1.1 Increased access to quality health services Strategies for the rural majority and the urban 1.3.1 Review the distribuon of the current available disadvantaged. workforce and priorise to place the right people with the right skills in the right places.

1.3.2 Increase the level of skills of health workers and Strategies improve the skills mix so they deliver the right

1.1.1 Increase the number of outreach services provided (quality) services. in rural areas and for the urban disadvantaged. 1.3.3 Increase movaon of formal and informal health

1.1.2 Improve the reliability of medical supplies distribuon workers through costed and government-approved and management. incenve schemes (such as housing and uniforms, medical cover, and school subsidies).

1.1.3 Improve availability and use of funding for operaonal acvies. 1.3.4 Ensure clinical supervision is provided in accordance with the Naonal Health Standards.

1.1.4 Increase funding for referral transport of paents from health posts and health centres. 1.3.5 Ensure specialists for all provincial hospitals will be available by 2030 as per the Naonal Standards.

1.1.5 Establish community health posts with facilies and sta to deliver maternal and child health services, including health promoon acvies in areas where Objective 1.4 they improve accessibility.

1.1.6 When medical doctors will be available, priorise Hospital infrastructure is rehabilitated. their placement to district hospitals.

1.1.7 Integraon of hospitals and rural health services into Strategies a single health authority.

1.4.1 Rehabilitate at least four major provincial hospitals (as regional specialist hospitals) to the approved Minimum Standards by 2030.

1.4.2 Establish a major new referral hospital in PNG by 2020. Chapter 4 The Way Foward Government of Papua New Guinea | 21 Naonal Health Plan 2011 2020

2.2.3 Implement strategies to increase the number Key Result Area 2: of trained health workers through innovave partnerships, such as private training schools or Strengthen Partnerships and scholarships. Coordination with Stakeholders Objective 2.3 The health sector works collaboravely with all stakeholders to expand the reach of quality health services. Strategies

2.3.1 Ensure the NDoH is the lead agency in supporng the Naonal Health Board to coordinate health development partner support (including NGOs).

2.3.2 Enhance communicaon, cooperaon, and reporng coordinaon with central agencies and other GoPNG Sectoral Departments, especially with the Departments of Treasury, Planning, Finance, and Provincial and Local Governments.

2.3.3 Engage community-based organisaons in planning and delivering health services.

2.3.4 Ensure all health service providers are compliant with relevant Acts and accreditaon requirements. Objective 2.1 The Naonal Public Private Partnerships Policy is Objective 2.4 implemented, and innovave and cost-eecve The health sector coordinates and monitors the opons for delivering services introduced. implementaon of the Naonal Health Policy. Strategies Strategies 4

2.1.1 Establish Public–Private Partnerships (PPPs) with 2.4.1 Ensure the health sector maintains the Naonal relevant major mining and agriculture ventures. Health Informaon System within a single operang

2.1.2 Establish health sector monitoring and coordinaon policy. mechanisms for PPPs. 2.4.2 Ensure all stakeholders receiving Government of Papua New Guinea or health development partner funding provide an annual report, including proposed Objective 2.2 future programming and expenditure. Expanded partnerships with resource 2.4.3 Ensure all stakeholders develop and build service developers, private health care providers, delivery infrastructure in accordance with the churches, and NGOs in rural (remote) areas and Naonal Health Service Delivery Policy and Naonal urban selements. Health Standards. Strategies

2.2.1 Improve purchaser–provider relaonships between private health care providers, churches, NGOs, and the resource industry.

2.2.2 Increase the use of outsourcing, when relevant, as a means of increasing public–private alliances/ partnerships. 4 The PNG Government policy denes PPP as those with pure capital investments over K50m. The Partnership Policy Framework (PPF) enables Government to use Civil Society Organisaons to implement some of its development programs. 22 | Government of Papua New Guinea Chapter 4 The Way Foward Volume 1 | Policies and Strategies Objective 3.2 Key Result Area 3: Quality workforce provided, capable of meeng Strengthen Health Systems the health needs into the future. and Governance Strategies

3.2.1 Develop a Naonal Human Resource policy and plan for the health sector.

3.2.2 Build the capacity of training instuons to reduce arion rates and provide appropriate cadres of workers for the workforce of the future.

3.2.3 Increase the annual output of qualied and accredited health workers to meet the needs of populaon growth.

3.2.4 Focus on increasing the numbers of nurses, midwives, and community health workers.

3.2.5 Increase the sta ceilings for crical health workers through evidence-based advocacy to central agencies.

3.2.6 Develop and implement a sector-wide human resource informaon system (HRIS) by 2012.

3.2.7 Outsource the management of Laloki for in-service training.

3.2.8 Develop and implement aordable health sector Objective 3.1 workforce recruitment and retenon strategies. Improve nancial resource management for health service delivery. Objective 3.3 Medical supply procurement and distribuon Strategies services are ecient and accountable.

3.1.1 Increase incrementally over ten years the overall percentage of GDP available for health services to meet the needs of populaon growth. Strategies

3.1.2 Improve ecient and eecve use of exisng 3.3.1 Improve the capacity of the procurement and nancial resources. distribuon systems within the health sector.

3.1.3 Facilitate an improved ow of funds to where it is 3.3.2 Outsource logiscs management and operaons for needed at the facility levels. the drug supply chain.

3.1.4 Develop and implement a single Health Sector 3.3.3 Implement 100% kit system for rural facilies unl Funding Plan and Strategy. 2015.

3.1.5 Instuonalise the Naonal Health Accounts. 3.3.4 Build the capacity of provinces and districts to

3.1.6 Explore opportunies for alternate health care implement the pull/demand systems for medical nancing. supplies.

3.3.5 Raonalise the number of area medical stores to two, and build the capacity of the provincial transit stores.

3.3.6 Provide the provinces with delegated authority from the Pharmaceucals Board to invesgate and prosecute fraud and corrupon in relaon to medical supplies. Chapter 4 The Way Foward Government of Papua New Guinea | 23 Naonal Health Plan 2011 2020 Objective 3.4 3.5.6 Implement whole-of-government reforms, and iniate health sector reforms, including consideraon The health sector proacvely idenes and of a Health Service Commission and a Health uses innovave and evolving ICT soluons and Endowment Fund. delivers accurate and mely informaon for 3.5.7 Ensure commiees such as the Naonal Health planning and decision making. Board, Audit Commiee, Professional Registraon Boards, and Pharmaceucal Board implement quality assurance programs and meet reporng Strategies requirements in compliance with legislaon.

3.4.1 Review, strengthen, and integrate the dierent 3.5.8 Review and update by 2020 all Acts of Parliament health sector management informaon systems pertaining to health administraon policies.

3.4.2 Improve capacity of districts to compile, analyse, 3.5.9 Review the Provincial Health Authories Act 2007 by and use informaon. 2012 and plan the roll-out to other provinces.

3.4.3 Establish by 2020 a common hospital paent informaon management system in all provincial hospitals, which is linked to a naonal paent master Objective 3.6 index. Strengthen health sector management and

3.4.4 Build the capacity of Provincial Health Informaon system capacity across Papua New Guinea. Ocers and Hospital Medical Records Ocers to compile, analyse, and provide quality informaon for district and provincial management. Strategies

3.4.5 Build the management capacity of the sector to 3.6.1 Provide leadership at all stages to develop and specify, acquire, implement, and manage major IT implement a health sector capacity development systems, both clinical and reporng. strategy and plan.

3.4.6 Implement by 2020 a naonal health sector-wide area network that connects all provincial capitals and Port Moresby to provide integrated communicaon and data services. Key Result Areas 4–8 Objective 3.5 The NHP uses the WHO framework for Improved leadership, governance, and implemenng primary health care, as management at all levels of the health idened in the World Health Report 2008, system. as well as the WHO framework for health system strengthening. Together these tools ensure a holisc, mul-sectoral, equitable, Strategies and ecient approach to strengthening

3.5.1 Ensure all partners and stakeholders develop health systems. implementaon plans in line with the single naonal health policy (the Naonal Health Plan) for their The following Key Result Areas relate to legislave compliance and reporng obligaons. the major health concerns, which are to

3.5.2 The Secretary of Health holds naonal and provincial be focused on improving the health of management sta accountable for the delivery of the naon. It is important to note that the services in accordance with the Naonal Health results related to these health outcomes Administraon Act 1997 and Provincial Health can be achieved only through combining the Authories Act 2007. work with the previous Key Result Areas.

3.5.3 Review and strengthen a performance monitoring Each naonal program will develop a ve- and evaluaon framework, including accountability year strategy dening the strategies and for use of funds, for all governance and management acons in more detail, including elements of authories within the health sector KRAs 1–3.

3.5.4 Strengthen management capabilies at naonal, provincial, district, and health facility levels.

3.5.5 Planning, budgets, expenditure, and management decisions are evidence-based and are linked to health priories. 24 | Government of Papua New Guinea Chapter 4 The Way Foward Volume 1 | Policies and Strategies Key Result Area 4: Objective 4.3 Improve Child Survival Decrease neonatal deaths. Strategies

4.3.1 Ensure that every facility has the capacity to provide life-saving support to the neonate.

4.3.2 Increase tetanus toxoid coverage of antenatal mothers.

4.3.3 Improve maternal health services, and improve supervised deliveries. Objective 4.4 Reduce malnutrion (moderate to high) in children under the age of ve years. Strategies

4.4.1 Advocate and promote exclusive breas_eeding.

4.4.2 Ensure all babies and children under ve have access to supplementary feeding when and where they require it.

4.4.3 Increase access for mothers and children to Objective 4.1 micronutrient supplementaon. Increase coverage of childhood immunisaon in all provinces. Strategies

4.1.1 Ensure every facility, every day, has the capacity to immunise children.

4.1.2 Conduct supplementary immunisaon programs every three years, or more frequently as needed. Objective 4.2 Reduce case fatality rates for pneumonia in children through acceleraon of roll-out of Integrated Management of Childhood Illnesses (IMCI) to all provinces. Strategies

4.2.1 Increase the number of health facilies that have the capacity to implement IMCI.

4.2.2 Increase the percentage of communies with the capacity to implement IMCI.

4.2.3 Ensure anbiocs are available every day, at every facility, to combat pneumonia in children under ve. Chapter 4 The Way Foward Government of Papua New Guinea | 25 Naonal Health Plan 2011 2020 Objective 5.3 Key Result Area 5: Improve access to emergency obstetric care Improve Maternal Health (EOC). Strategies

5.3.1 Increase the capacity of all facilies to provide essenal EOC.

5.3.2 Increase the number of facilies capable of providing comprehensive obstetric care.

5.3.3 Ensure every maternal death is invesgated and audited, and pracce improved. Objective 5.4 Improve sexual and reproducve health for adolescents. Strategies

5.4.1 Increase the knowledge of adolescents about sexual and reproducve health.

5.4.2 Increase cross-sectoral collaboraon with schools to strengthen educaon of students in sexual and Objective 5.1 reproducve health. Increase family planning coverage. Strategies

5.1.1 Ensure every health facility has the capacity to oer family planning services at all mes.

5.1.2 Advocate for the advantages of having fewer children and increased spacing of children.

5.1.3 Extend the reach of the village health volunteers (VHV) program and community-based distribuon systems. Objective 5.2 Increase the capacity of the health sector to provide safe and supervised deliveries. Strategies

5.2.1 Increase the number of facilies capable of providing supervised deliveries.

5.2.2 Increase the numbers of health workers skilled in obstetric care.

5.2.3 Ensure every health facility is capable of providing quality service/support before, during, and aer pregnancy. 26 | Government of Papua New Guinea Chapter 4 The Way Foward Volume 1 | Policies and Strategies

6.2.3 Ensure a sucient number of quality-assured Key Result Area 6: laboratories are established and funconing eciently under the coordinaon of the Central Reduce the Burden of Public Health Laboratory (CPHL). Communicable Diseases 6.2.4 Ensure every person who is HIV posive has access to TB DOTS. Objective 6.3 Scale up prevenon, treatment, care, and support for sexually transmied infecons (STIs) and HIV to meet universal access targets. Strategies

6.3.1 Increase access to quality HIV counselling and tesng services.

6.3.2 Increase access to quality anretroviral (ARV) treatment for adults and children.

6.3.3 Ensure male and female condoms (and lubricants) are available and accessible throughout the country.

6.3.4 Increase access of the general populaon to post- exposure prophylaxis (PEP) services.

6.3.5 Ensure every facility is able to provide prevenon of parent-to-child transmission (PPTCT) services. Objective 6.1 Reduce malaria-related morbidity and mortality Objective 6.4 in Papua New Guinea. Strengthen communicable disease surveillance and monitoring. Strategies

6.1.1 Strengthen polical commitment for malaria control. Strategies

6.1.2 Improve vector control measures, with a priority 6.4.1 Introduce an integrated surveillance and monitoring of all households having access to a long-lasng strategy for communicable diseases. inseccidal net (LLIN), and a reintroducon of

6.4.2 Strengthen epidemic surveillance and response residual spraying where appropriate. capacity for communicable diseases with a potenal

6.1.3 Maximise access to prompt quality diagnosis and for outbreaks. appropriate treatment for malaria.

6.4.3 Improve access to quality and appropriate rapid diagnosc and laboratory tesng services at facility, Objective 6.2 province, and naonal levels. Control tuberculosis (TB) incidence by 2020, with a decline in cases of mul-drug resistant tuberculosis (MDR-TB). Strategies

6.2.1 Strengthen polical commitment for TB control.

6.2.2 Implement a quality and supervised Tuberculosis Directly Observed Treatment, Short-course (TB DOTS) program in every province by 2015. Chapter 4 The Way Foward Government of Papua New Guinea | 27 Naonal Health Plan 2011 2020

7.2.2 Ensure all health facilies have access to running Key Result Area 7: water, and eecve waste disposal and sanitaon.

7.2.3 Ensure public and private buildings comply with Promote Healthy Lifestyles legislaon in relaon to water supply, sanitaon, and food handling.

7.2.4 Review and improve relevant legislaon to enhance the management and control of rural water supplies. Objective 7.3 Increase individuals’ and communies’ involvement in their own health. Strategies

7.3.1 Increase the roll-out of the Healthy Islands strategy.

7.3.2 Extend the reach of community-based health care, including enhancing village volunteer programs.

7.3.3 Implement strategies that empower the community and the individual to take ownership and direcon of their health and the health of their families. Objective 7.4 Reduce morbidity and mortality from Objective 7.1 non-communicable diseases. Increase health sector response to prevenon of injuries, trauma, and violence with an impact on Strategies families and the community.

7.4.1 Increase the focus on populaon-based health awareness intervenons designed to reduce the impact of substance abuse, increase the level of Strategies physical acvity, and improve diet.

7.1.1 Increase the advocacy for populaon-based health 7.4.2 Increase early detecon (screening) and immediate awareness intervenons designed to reduce the clinical intervenons for non-communicable number of preventable injuries and trauma. diseases, such as heart disease, strokes, diabetes,

7.1.2 Increase the roll-out of and access to family support and cancers. centres to reduce the impact of violence in the home 7.4.3 Ensure all government facilies promote healthy and community. lifestyles and schedule healthy workplace acvies.

7.1.3 Increase the capacity of hospital accident and 7.4.4 Review and improve legislaon that will support the emergency departments to address transport- adopon of healthy lifestyles. related injuries.

7.4.5 Improve and expand the standards in mental health service delivery. Objective 7.2 7.4.6 Improve the provision of disability aids/appliances, physiotherapy, and community-based rehabilitaon Reduce the number of outbreaks of food and services. water-borne diseases. Strategies

7.2.1 Increase the number of households that have access to safe drinking water, and eecve waste disposal and sanitaon. 28 | Naonal Department of Health Chapter 4 The Way Foward Volume 1 | Policies and Strategies Objective 8.2 Key Result Area 8: Improve Preparedness for Increase capacity of the Central Public Health Laboratory (CHPL) to provide services to meet Disease Outbreaks and Emerging urgent and emerging concerns. Population Health Issues Strategies

8.2.1 Ensure the CPHL (including all provincial laboratories) has sucient capacity and supplies at all mes to support a naonal response to disease outbreaks and other emergency health concerns.

8.2.2 Ensure a funconing and safe blood transfusion service is available to the health sector, and includes HIV blood screening capability.

8.2.3 Ensure the CPHL provides support for clinical diagnosis and public health funcons to provincial laboratories. Objective 8.3 Improve capacity and preparedness of the health sector to address the impacts of climate change. Objective 8.1 Strategies

8.3.1 Increase cross-sectoral collaboraon to prepare for Increase capacity of the health sector to idenfy, impacts of climate change on the health of Papua monitor, and report on urgent and emerging New Guineans. health threats.

8.3.2 Ensure every health facility has a Disaster Preparedness Plan, including issues associated with climate change. Strategies

8.1.1 Establish a Naonal Public Health Instute, incorporang a Centre for Disease Control (including Objective 8.4 response). Ensure the health sector works collaboravely to

8.1.2 Strengthen surveillance systems for detecng and manage populaon health threats related to the responding to epidemics. growing resources boom.

8.1.3 Strengthen capacity of the health sector to report on noable diseases in accordance with internaonal regulaons. Strategies

8.1.4 Increase the capacity of provinces to coordinate 8.4.1 Strengthen the regulatory role of the health sector to their responses to epidemic and populaon health reduce the adverse health impact on the populaon emergencies. of development projects.

8.4.2 Ensure private sector health facilies (mining and agricultural) support naonal surveillance systems. Chapter 4 The Way Foward Government of Papua New Guinea | 29 Naonal Health Plan 2011 2020 Health Vision 2050 — Directions for In accordance with geographical and populaon the Next Forty Years catchment requirements, District Hospitals will gradually be introduced to most districts, and will Health Vision 2050 is a forty-year strategy that will each over the forty-year period be progressively transform the current health service delivery system staed with a doctor. A new Rural Doctor’s Program in Papua New Guinea, and links to the Naonal will be developed and implemented by Divine Word Government’s Papua New Guinea Vision 2050 and University with this operang environment in mind. the PNG Development Strategic Plan 2010–2030. It The introducon of this facility across districts will includes the progressive introducon of community begin to address the demand for more complex health posts, district hospitals, regional specialist obstetric care at a more local level. Clinical services hospitals, and naonal referral hospitals, and also provided at District Hospitals will include general incorporates the requirements of two new provinces. surgery, maternal and child health, malaria, HIV/AIDS, This new referral model, underpinned by strengthened and TB diagnoscs, as well as health promoon, health health systems will create an enabling environment improvement, and health protecon. to reverse our deteriorang health indicators, and to reduce the accessibility gap for our rural majority and Provincial Public Hospitals will be progressively rehabilitated and upgraded during the forty-year for those living in disadvantaged urban sengs. period. In general, these hospitals will provide, The strategy underpinning Health Vision 2050 as a minimum, the following clinical services: acknowledges that service delivery improvement is Internal Medicine, Surgery, Paediatrics, Obstetrics required at all levels of the health care referral model. It and Gynaecology, Accident and Emergency, and further acknowledges the need for greater integraon Anaesthecs. Health promoon, health improvement, between hospital and rural health services (both and health protecon services will also be provided. In public and church-managed), and seeks to maximise provinces where the hospital performs a dual role as a the use of the human and other resources available to specialist regional hospital, addional clinical services the sector. Furthermore, considering the uidity of the will be provided as menoned below. populaon at any one me, it is recognised that the It is proposed that four specialist hospitals be rst point of access to the system may be at any level, established, with one located in each region within including hospitals. Papua New Guinea. The approach acknowledges the manpower constraints within PNG (specically that of Components of Health Vision 2050 specialist medical ocers and specialist nurses) and Community Health Posts will be the new outer seeks to maximise access for the populaon to these periphery of the health system, staed by three health services through establishing centres of excellence. workers skilled in maternal and child health, midwifery, These Specialist Regional Hospitals will therefore health promoon, and community awareness have a mul-faceted role as a naonal specialist hospital (for example, provision of oncology services programs. These facilies will be slightly larger than for the country), as a provincial hospital catering to its the current Aid Posts, and dier by the inclusion of a individual province, and as a regional hospital catering labour room. It is ancipated that supervised deliveries to the needs for complex treatment of paents from and roune immunisaon will be conducted from its individual region. these points. A new focus for these facilies will be improving the interface between the community and Pacic Medical Centre will be developed as a 100% formal health services, ensuring that the community not-for-prot, state-of-the-art, full-service teaching knows how to access the appropriate level of care, as hospital, to benet the enre country. It will: well as equipping them with the necessary skills and (a) Serve as the naon’s centre of excellence in health knowledge to beer take responsibility for their own care, where the world’s best pracces in health care healthy living. This laer aspect will be enhanced by and medicine will be provided and demonstrated to encouragement of the use of informal health care benet Papua New Guineans, in collaboraon with from the community and family level, including, for public hospitals and some of the world’s leading example, Village Health Volunteers. teaching hospitals. Health Centres will remain the intermediary referral (b) Serve as the naon’s leading referral hospital for point between Community Health Posts and District urgent and crical care needs that are beyond the Hospitals, ensuring an accessibility gap does not widen capacity of any public hospital in PNG. as reforms are introduced. 30 | Government of Papua New Guinea Chapter 4 The Way Foward Volume 1 | Policies and Strategies (c) Become a centre of excellence in postgraduate • Rehabilitaon of Aid Posts and connuing medical educaon, including • Establishment of Community Health Posts and professional training aimed at improving the expansion in strategic locaons skills of naonal physicians, nurses, hospital administrators, biomedical engineers, and other • Rehabilitaon of Health Centres ancillary sta working in public hospitals in PNG. • Rehabilitaon of current District Hospitals, and (d) Become the naon’s centre of excellence in medical expansion of the number of these in strategic research in useful areas of health and medicine, districts in collaboraon with naonal instuons, such as the UPNG School of Medicine and Health • Rehabilitaon of Strategic Provincial/Regional Sciences, PNG Instute of Medical Research, and Hospitals other local universies, including in partnership • Rehabilitaon of PMGH with parcipang university medical centres and hospitals, and other global health care partners in • Establishment of a new naonal referral hospital for the United States and around the world. PNG. A Naonal Instute for Public Health will be The implementaon schedule is detailed on the established, incorporang Centres for Disease Control following page. While this is designed as a forty-year and Health Policy Management. This facility will schedule, the sequencing in the rst ten years will provide guidance in policy development and planning re ect the funds available, and the focus on a back for the sector. to basics approach and rehabilitaon of rural health services. The implicaons of Health Vision 2050 for the immediate ten-year period of the Naonal Health Plan 2011–2020 include: Figure 19 Health Vision 2050 CURRENT FUTURE SCENARIO: Health Vision 2050 STRUCTURE 2010 Governance Naonal Referral Hospital ‘Pacic Medical Naonal Government PMGH Centre’ through Hospital Boards Regional Specialist Hospitals Provincial Public Provincial Public Hospitals Hospitals Provincial Provincial Health Authority District District Hospitals Hospitals Health Health Centres Centres absorbed Health Community Community Community Sub-Centres Health Post Health Post Health Post upgraded Aid Community and Family Care Posts (to be provided by community and civil society) Chapter 4 The Way Foward Government of Papua New Guinea | 31 Naonal Health Plan 2011 2020 Figure 20 Health Vision 2050 — Implementation Schedule Facility Type Phase 1 Phase 2 Phase 3 Phase 4 2011–2020 2021–2030 2031–2040 2041–2050 Community Health Posts Phase 1 (a) Rehabilitate and open Aid Posts Phase 1 (b) Establish CHPs in strategic locaons Phase 2 Progressively replace Aid Posts and Health Sub-Centres with CHPs Health Centres Rehabilitate all Health Centres to become fully operaonal District Hospitals Establish one fully operaonal hospital in most Districts over 40 years (note: in Districts without co- located Provincial Hospitals) in accordance with populaon/geographical requirements Provincial Health Authories Roll-out PHAs Provincial Hospitals Phase 1 Key Provincial Hospitals fully operaonal over 20 years including teaching Hospitals Phase 2 Remaining Provincial Hospitals fully funconal Regional Specialist Hospitals Feasibility Establish four Regional Specialist Extend services and technology as funds become Studies Hospitals over 20 years available Rehabilitaon of PMGH PMGH refurbished Naonal Referral Hospitals New Hospital Further consideraon of new referral hospitals built ‘PMC’ 32 | Government of Papua New Guinea Chapter 4 The Way Foward Volume 1 | Policies and Strategies Chapter 5 Implemenng the Plan The best plan, the greatest plan, is the one we achieve. Professor David Kavanamur Implementaon is the process of turning a policy into 3. Planning mechanisms within the levels of pracce. It is common to observe a gap between what government and other service providers. was planned and what occurred as a result of a policy; 4. Linkages with the whole-of-government planning or to nd out that much of what was intended to be mechanism. implemented was never done. The health sector is such a complex area that an overall health policy has 5. Accountability and performance of dierent policy much less chance of being implemented as planned implementers. than a simple, straigh_orward policy aiming to change 6. Close partnerships. one single issue. 7. Eecvely managing risks. Keeping this in mind, the central level policy-makers of the Naonal Health Plan 2011–2020 have concluded 8. Planning a strategic implementaon process. that in the current PNG environment there are several issues to be taken into account to enhance the policy Involvement of Stakeholders implementaon. These include: From the very beginning of the NHP development unl the nal version, various stakeholders have been 1. Wide involvement of various stakeholders in the involved. This has included a wide variety of instuons NHP development process. and individuals, as well as the general public. Overall, 2. Emphasis on values of service providers and health the interest in the NHP has been extensive, indicang workers. commitment to implement the NHP and also raising expectaons for the NHP to be able to spearhead the major changes required. Chapter 5 Implemenng the Plan Government of Papua New Guinea | 33 Naonal Health Plan 2011 2020 Values: The Foundation for Naonal Health Standards Implementation Under the previous Naonal Health Plan 2001– The extent and the quality of implementaon of the 2010, health service standards were directed by the Naonal Health Plan depends on polical will, enabling Minimum Standards for District Health Services, and resources and systems, and parcularly on the manner Hospital Standards and Standard Treatment Manuals in which health professionals perform their work. for the curave health services. A single integrated and updated set of Minimum Standards will be developed To realise the Vision of this Plan, all health workers, for the period of this NHP. It will include standards for administrators, and support sta within the health services, facilies, workforce, and others. Provinces, sector, need to ensure the Values idened in Chapter hospitals, and PHAs will use these standards set by 4 underpin all that we do. NDoH when developing their plans. Naonal Program Five-year Strategic Implementaon Roles and Responsibilities of Plans Different Levels of the Sector Each program will develop its ve-year strategic plan Implementaon of this Plan will be in accordance with on the basis of the NHP. These provide guidance on the recognised dierent levels of responsibility: program priories, and up-to-date, proven, and cost eecve intervenons. The respecve branches in the • Naonal — policy, standard seng, technical advice Naonal Department of Health have the responsibility and monitoring to provide high-level technical support to the provinces, • Provincial — overseeing implementaon as they develop and implement the provincial plans. • District — implementaon. Annual Acvity Plans Acvity plans are made for each year, at the naonal Planning Hierarchy within the level by and for the NDoH branches. These plans are Health Sector directed by the NHP and the plans menoned above. National Level The naonal government is also responsible for Chapter 2 described how this Plan receives its developing dierent policy instruments to enhance overarching direcon from key long-term GoPNG the implementaon of the NHP. These will include documents. The purpose of this chapter is to further changes in and introducon of new legislaon and explain how specic health sector strategies and regulaons and contracng. planning cascade from the Naonal Health Plan. Provincial Level The NDoH will develop medium-term (5 years) Provincial Development Plan strategic plans. They will guide the development of naonal health program plans and provincial health Provincial administraons develop ve-year plans (see below). The plans draw from the overall development plans to guide sectors. These are aligned GoPNG Medium-Term Strategies, namely the Medium- to the MTDP and NHP priories. The health sector Term Fiscal, Manpower, Development, and Reform uses this informaon in the development of ve-year Strategies. Provincial Health Sector Implementaon Plans. During the course of this current NHP, two ve-year health Medium Term Development Plan sector implementaon plans will be completed. The NDoH will work with the Department of Provincial Five-year Health Sector Implementaon Naonal Planning and Monitoring to develop the Plan ve-year Medium Term Development Plan (MTDP) for health. The MTDP priorises and sequences the Health service delivery in each province is guided implementaon policies and acvies of sectors and by the ve-year health sector implementaon plan, links resources to outputs. which directs all health sector service providers. These medium-term plans will take their direcon from Naonal Health Sector Development Plan the NHP and the specic Naonal Program Five-year During the period of the current Naonal Health Plan, Strategic Implementaon Plans, as well as the overall two ve-year Naonal Health Sector Development Provincial Development Plan. Plans will be developed. These plans link to the According to their mandates, provinces must develop MTDP and collate informaon from the Provincial plans that are in line with the NHP and its priority Development Plans. They also include informaon strategies, as well as the specic objecves and that idenes strategic capital investment projects. strategies. 34 | Government of Papua New Guinea Chapter 5 Implemenng the Plan Volume 1 | Policies and Strategies Annual Acvity Plans plans at each level of administraon lies with the Acvity plans include acvies that will be PLLSMA at the naonal level, and with the PCMCs at implemented by each management unit, the cost, the provincial level. These coordinang mechanisms meframe, source of funds, and means of vericaon. play a crical role in facilitang dialogue and advocacy Standard templates will be updated to re ect the across sectors, and will be increasingly used as part of evolving ‘whole-of-government’ concepts in the the implementaon structures for the new Naonal development of annual district and local level budgets Health Plan. and plans (see below). Impacts of Whole-of-Government Reforms The Provincial Annual Acvity Plan is a yearly on Health Sector Implementation consolidated acon plan and should be developed jointly with all service providers, public and private. The implementaon of this Plan, and indeed all of the The District Annual Acvity Plans, again developed proposed plans detailed above, will take place in the by all the service providers in the district, form the context of signicant ongoing ‘whole-of-government’ core of the Provincial Annual Acvity Plan. Over the reforms. Of those that directly have an impact on the period of this Naonal Health Plan, concerted eorts health sector, perhaps the most important are the will be made to encourage and improve Facility Level recent changes to the system of intergovernmental Planning. Given the intenon to roll out reforms to nancing5. Not only do these reforms ensure a more enable direct facility funding, each health facility equitable transfer of resources from the naonal to should be able to plan and budget autonomously provincial level, but they also help to clarify the service according to a dened resource envelope. Aggregaon delivery responsibilies of each level of government. of Facility Level Plans will comprise the core of the Other reforms currently being pursued by the GoPNG District Annual Acvity Plan. are eorts to make decentralisaon work. The health Provincial Health Authority sector is sll coming to grips with the dislocaon wrought by the introducon of the Organic Law on Planning by the PHAs in the provinces will be consistent Provincial and Local-level Governments (OLPGLLG, with the planning framework. The standards, guides, or the ‘new organic law’). The Naonal Health and templates will be developed by the NDoH and will Administraon Act 1997 was an early response to be used across the sector. this dislocaon, but a more praccal soluon to the disrupon of vercal management of health services Ongoing Integration of Health in the provinces was only embraced following the Sector Planning with Whole-of- passing of the Provincial Health Authories Act 2007. Government Priorities The Provincial Health Authories Act 2007 made The challenge for any implementaon process is provision for Provincial Health Authories to be to ensure that naonal priories and strategies are established in each province. Management of hospitals adequately translated and incorporated into the and rural health services, and therefore all health annual operaonal plans of central and provincial workers in the province, could once again be managed governments. The role of the Joint Planning and Budget under a unied authority. This system is being piloted Priories Commiees at the provincial and district at the me of developing this NHP. It is expected that levels are crucial in promong boom-up planning. an accelerated roll-out of this ground-breaking reform Each local level government plan is expected to re ect will commence as results of the pilot become clear. the needs and priories of communies, while each provincial plan is expected to relate to local realies and naonal priories. (This is illustrated in the ‘Kundu Approach’ described in Chapter 2.) Similarly the implementaon of health sector naonal priories and strategies face this same challenge, and operate within the same system of both boom-up and top-down planning. The key to ensuring synergy between health sector and whole-of-government 5 These reforms, largely directed by the Naonal Economic and Fiscal Commission under the broad banner of ‘Reform of Intergovernmental Financing Arrangements’ (RIGFA), were brought into eect by the Intergovernmental Relaons (Funcons and Funding) Act 2007. Chapter 5 Implemenng the Plan Government of Papua New Guinea | 35 Naonal Health Plan 2011 2020 Empowering Individuals and Communities Integrang the provision of health services with The extensive consultaon process conducted to educaon services6 is a part of the long-term vision inform this Plan, coupled with the insights provided by for Community Health Post roll-out, and will need analysis of the evidence presented in Volume 2, has to be supported by reliable and accessible transport revealed the need to strengthen the focus of health networks and commercial services, as outlined care provision in a manner that will ensure all Papua within GoPNG Vision 2050. Improving the whole New Guineans are empowered to be involved in, and spectrum of services available at the local level will responsible for, their own health. This is re ected contribute to both healthier lives for individuals and within Key Result Area 7 Promote Healthy Lifestyles. securing the long-term dedicaon of health workers Achieving a prevenon-focused approach to health in to rural areas. PNG will involve: • Working more eecvely with mulple players at • Ensuring formal health services are brought closer the local level, including churches, NGOs and private to the community, parcularly to those groups of organisaons looking to provide health care to their people living in remote rural areas and those living employees and surrounding communies. in disadvantaged urban areas. • Extending the reach of health promoon and Accountability and Performance awareness acvies from health facilies to each Monitoring community. The Community Health Post roll-out To improve implementaon of the NHP, informaon will incorporate a dedicated health worker to on performance is crucial. A Performance Assessment community engagement/awareness acvies and Framework has been developed and it will provide the will encourage and supervise the growth of informal dierent levels of government with a tool to measure health services within communies such as Village performance and to hold the lower ers accountable Health Volunteers, Village Health Commiees, and for the use of resources (see Chapter 8). The ways safe pracce of tradional medicine. that eecve or poor performance will be rewarded or discouraged is a management issue and should be • Eliminang barriers to the access of health planned for. services caused by both geographic factors and economic factors. Protecng the rights of access for However, performance indicators alone do not give parcularly vulnerable groups, such as women and an appropriate picture of what is happening and girls, vicms of domesc violence, and individuals what is not in implementaon. At all levels, health wishing to seek services free of discriminaon (for managers need to keep themselves closely informed example, sexual and reproducve health services) is through specic informaon gathering, observaons, an imperave which will be upheld at all levels of and consultaons, to nd out the reasons for any implementaon. deviaons in implementaon and to take acon, either to improve the implementaon or to revise the policy. • Improving the access of each village and every household to safe water and sanitaon. An important part of the NHP will be implemented by the private sector, namely the churches. Accountability • Ensuring health facilies at every level of the system on both sides, government and the churches, has are equipped to cater for the provision of high room to improve. Making use of purchaser–provider quality care for mothers and children. Rehabilitang relaonship tools will bring change and enhance the facility infrastructure, water supplies and sanitaon, NHP implementaon. and renewing basic clinical equipment and assets (for example, immunisaon refrigerators) is a high As part of its responsibility to monitor the overall priority of this Plan. implementaon of the NHP, the NDoH will establish a Project Implementaon Coordinaon and Monitoring • Working with all sectors to improve the delivery Unit to monitor the progress of capital investment of the full complement of services required at the priories. community level for a beer of standard of living. 6 Results of the PNG Demographic and Health Survey of 2006 show a strong correlaon across a number of the health measures between more years of educaon and beer health. The report shows that greater years of educaon for girls results in delayed commencement of child bearing and correlates with improved spacing between children. Mothers who have received more educaon are less likely to give birth at home. Higher educaon levels are also linked to greater knowledge of methods and sources of family planning, and with improved care of infants and children. With respect to health promoon, women who have aained higher educaon levels show greater use of mass media. 36 | Government of Papua New Guinea Chapter 5 Implemenng the Plan Volume 1 | Policies and Strategies Partnerships Risk Management The pursuit of a sector-wide approach (SWAp) for Managing risks is the key to successful implementaon health, and the emergence of many of the building of any plan. While this NHP has been developed to blocks of such of an approach, was a feature of health be achievable in the known environment of PNG, sector development over the past decade. In the some assumpons made will be strongly challenged coming decade, a realigned sector-wide approach will if the revenues expected from the LNG Project do further consolidate the leadership role of the Naonal not materialise. On the other hand, if infrastructure Department of Health. In this context the Naonal development funds are made available, then the Health Plan states the common vision, strategies, and capacity of the country’s building industry to meet the outcomes to guide all partners in their inputs to the demands of the economic boom will be tested and sector. may have an impact on the Plan’s objecves. The Medium Term Expenditure Framework will play A crical success factor in achieving the Plan’s outcomes an enhanced role in facilitang the coordinaon of is the focus on a back to basics/primary health care sector nancing, while the monitoring and evaluaon approach. A lack of available funds and/or a loss of framework outlines agreed outcomes and provides a this focus may result in a worsening situaon for rural basis for joint reviews and performance monitoring. health services and health indicators in general. Improving service delivery in health will be dicult It will be essenal for the health sector to monitor without also strengthening partnerships within and these risks and re ect their impact in annual reporng. beyond the health sector. The long and successful partnership with the churches has potenal to evolve Roll-out of Strategic in line with the new challenges faced by the sector. Implementation Planning Improved relaonships with central agencies will The naonal level policy-makers will develop planning be essenal for the health sector to secure support guides and templates to enhance and encourage in resource allocaon and advocacy at the highest the implementaon of the NHP. This will include polical level. management of uncertainty and risks and instung Health will be acvely involved in broader GoPNG mechanisms for consultaons, monitoring, and ne- eorts to improve coordinaon of service delivery tuning the NHP. implementaon. The Provincial and Local Level Through these documents, the naonal level will be Services Monitoring Authority (PLLSMA) and Provincial in close contact with the implementers and aiming to Coordinaon and Monitoring Commiees (PCMCs) respond to the dicules encountered and support provide ready-built interacon points for health sector the front-line health workers. stakeholders to align their acvies with other service delivery agencies. In addion, approved recommendaons from the SWAp review will be incorporated into implementaon of the Plan, to ensure the goal of ‘one Plan, one budget’ is achieved. Chapter 5 Implemenng the Plan Government of Papua New Guinea | 37 Naonal Health Plan 2011 2020 38 | Government of Papua New Guinea Chapter 5 Implemenng the Plan Volume 1 | Policies and Strategies Chapter 6 Financing the Health Sector Background fold increase in the value of health funcon grants As the PNG health sector moved ahead with over the corresponding period. implemenng a sector-wide approach (SWAp) in the In fact, as Figure 22 shows, the actual levels of funding early stages of the previous Naonal Health Plan for rural health service operang costs now almost period, it was understood that a key building block match the Naonal Economic and Fiscal Commission would be a framework to manage sector expenditure esmates of what is required to cover the costs of a and potenal funding shor_alls. As the Medium Term minimal level of service delivery7. Yet despite these Expenditure Framework (MTEF) has expanded and welcome improvements, it is clear that this addional improved since its inial development early in the last funding is not being adequately transformed into decade, it has helped reveal more about the nature tangible improvements in health outcomes. One of of how the health sector is nanced in PNG. Most the key lessons of the past decade is that more money immediately, it is clear that in recent mes, overall by itself does not lead to improved service delivery. government-funded recurrent service expenditure has increased substanally. While this Plan envisages that more money will ulmately be needed in the health sector to achieve Figure 21 reveals that, in parcular, overall personnel the necessary improvements in the future, it recognises expenditure — inclusive of church health services that far greater aenon must be paid to ensuring and provincial general hospitals — has increased by more eecve usage and allocaon of our exisng almost 60%. Overall, expenditure on operaonal costs nancial resources. The health sector will focus on for rural health services has doubled between 2007 pung its exisng nancial resources to beer use and 2010, largely due to changes to the system of over the next decade. intergovernmental nancing, which have seen a three- 7 Esmated Operaonal costs (Goods and Services, excluding medical supplies) — Rural Health Services. NEFC costs adjusted to 2010 prices. Chapter 6 Financing the Health Sector Government of Papua New Guinea | 39 Naonal Health Plan 2011 2020 Figure 21 Recurrent Expenditure — Rural and Hospital Services 2007–2010 Expenditure Appropriations Recurrent Expenditure 2007–2010 (K'million) 2007 2008 2009 2010 Personnel Expenditure (PGH, RHS) 225 258 315 355 Medical Supplies 59 75 80 93 Operonal costs: General Hospitals 34 44 53 62 Rural Health Services: Church services 14 14 17 18 Central Health Grants (200) 13 15 28 39 HSIP 8 10 13 17 Internal Revenue (700) 6 6 6 6 Total Rural Health Services 40 45 65 80 Total `peraonal costs 74 88 118 143 Total Recurrent Costs 358 421 513 591 Figure 22 Goods and Services, excluding Medical Supplies — Rural Health Services (NEFC cost estimates) Estimated Goods and Services Costs (K'million) Facility operations and outreach: Financed by: Government facilies 18 Health Fun<on Grants 39 CHS  <  18 Internal revenue 6 Total facility costs 37 HSIP 17 { ents transfers 24 CHS     grants 18 Medical supplies distribuon 4 Province/district $!  18 Total (excluding rural water supply) 83 Total RHS nancing 80 Re ecng this focus, the remainder of this secon will Resource Usage consider: In recent mes, the drive to increase funding of the • Resource usage: How our nancial resources are resource envelope for the health sector has tended spent. to overshadow the clear opportunies available for Papua New Guinea’s health sector to improve within • Resource allocaon: Allocang our nancial the exisng nancial situaon. resources more eecvely. As suggested above, it is arguable that the PNG health • Resource mobilisaon: How to obtain addional system should be funconing more eecvely given nancial resources to close possible gaps. that the MTEF shows public expenditure on health (including contribuons from development partners) in 2010 is approximately K925m. This equates to public expenditure on health of around K140 per capita. 40 | Government of Papua New Guinea Chapter 6 Financing the Health Sector Volume 1 | Policies and Strategies The suggeson that the total of funds available to In addion, it will work to improve its own nancial the health sector is perhaps more adequate than management systems and increase accountability for previously thought seems to contradict the experience the health sector’s use of its resources. at the facility level, where front-line service sta report being impeded in their eorts by the lack of Resource Allocation operaonal funds. In addion to eecve usage of nancial resources, it is The reason for this inconsistency is that health sector vital that these same nancial resources are allocated funds are not being eecvely used. Too many funds — that is, distributed — across the sector eciently, are ulmately not reaching their intended desnaon. and in a manner that will generate the best possible outcome. Findings from the Case Study of District Service Delivery conrm the problems of geng funds out to In recent mes, coinciding with improvement of the facilies, and indicate that facilies to a fairly large the MTEF, and the contribuon of various studies, extent charge user fees to compensate for the lack of a holisc, whole-of-government, sector-wide funds and resources in the facilies. The study also perspecve has become clearer. This perspecve is an pointed to a tendency of funds budgeted by provinces essenal prerequisite to achieving improved resource for increased program administraon purposes and allocaon. The development of a single Health Sector not front-line services. In addion, there are increasing Funding Plan and Strategy (KRA 3.1.3) will facilitate Indicaons that provinces cannot spend the increased improved sector-wide nance decision-making. amount of funds. Figure 23 demonstrates the need to consider resource The Naonal Economic and Fiscal Commission (NEFC) allocaon decisions from a sectoral perspecve. have aempted to quanfy the extent to which actual It reveals that health sector nancial resources, resource usage does not match the intended purpose represented by sta, facilies, and operang costs, are of health sector funding. Their analysis8 shows that in not distributed equitably across the country. 2007, provinces on average funded only 21% of the Those groups of provinces that have relavely poor actual costs required in health, but on average spent service indicators are not as well-resourced, in per 197% of the actual costs required for administraon. capita terms, as those with relavely beer service It is crical that funds reach the point of service indicators. For example, there is on average almost delivery, which is the health facility level. Evidence twice as many service sta per 10,000 people in from both the Case Study of District Service Delivery the least well-served group of provinces than in the and the Rural Health Services Cosng Model reveal relavely well-served group. that lack of operang funds and medical supplies at Similar discrepancies exist in terms of the operang the facility level have been key inhibitors of improved costs available to health workers in dierent provinces, service delivery9. Because health sta compensate for and with the number of facilies per populaon. To their lack of resources by charging user fees, equitable achieve a more equitable distribuon of health sector access to health services is compromised. resources, a gradual relave shi to strengthen service To ensure health sector funding reaches the service capacity resources to the less well-served provinces is delivery front-line, the Naonal Department of Health required. will implement direct facility funding. Districts and One of the current dicules to implemenng provinces will maintain oversight and management allocaon changes is the sheer number of players, who responsibilies, and retain their ability to direct individually decide how to allocate their share of the funding allocaon, but once allocated funding will total health sector nancial envelope. This oen means be channelled directly to facility accounts. This will that allocaon decisions for dierent components empower facility sta to manage their own budgets. of the health system are made in isolaon from the The Naonal Department of Health, on behalf of the broader nancial implicaons. The collecve eorts of health sector, will also engage with central agencies all health sector players are needed to ensure nancial to recfy the slow movement of funds through resources are allocated where they are most needed. the government’s nancial management system. 8 See NEFC (2008), Closing the Gap: Review of All Expenditure in 2007 by Provincial Governments. 9 Rural Health Services Cosng Model. Chapter 6 Financing the Health Sector Government of Papua New Guinea | 41 Naonal Health Plan 2011 2020 Figure 23 Distribution of Health Services and Resources Per Capita by Provinces Provinces ranked by service indicators per capita Operating costs Service Facilities NEFC Funds staff per per per per Province Population Disch. OP Deliv. 10,000 10,000 cap cap Eastern Highlands 515,307 Southern Highlands 759,183 Morobe 672,755 2.9% 0.97 0.24 8.7 0.8 8.46 7.80 Simbu 299,543 Western Highlands 536,128 North Solomon 200,278 Central/NCD 557,966 4.2% 1.16 0.43 13.0 0.9 9.53 8.21 Enga 370,844 Northern 164,675 East Sepik 408,447 Madang 451,834 West Sepik 224,546 4.1% 1.79 0.34 13.0 1.2 18.35 19.27 Manus 53,276 Milne Bay 256,366 Gulf 131,264 East New Britain 268,211 West New Britain 242,963 5.6% 2.11 0.54 17.1 1.4 20.80 17.52 Western 198,775 New Ireland 148,761 Total 6,461,122 3.9% 1.38 0.37 12.1 1.02 12.79 11.88 To assist in improving health sector resource allocaon, The Model will be improved as more informaon evidence and informaon for policy-making will be comes to hand, and is integrated into the MTEF. improved. The Medium Term Expenditure Framework (MTEF) currently helps to demonstrate to policymakers Resource Mobilisation the total pool of funds available to the health sector, Expenditure on health in Papua New Guinea remains and the esmated requirements. Use of the MTEF overwhelmingly publicly-funded, and is likely to will be enhanced, and its links to policy-making and remain so. In 2010, the enre publicly-funded resource nancial allocaon decisions strengthened. envelope available to health, as calculated by the Improving our understanding of health sector costs is MTEF, is approximately K925 million. Of this, a lile another way to improve evidence and informaon to more than 30% is provided by development partners. help policymakers make beer decisions about how to Reliance on development partner expenditure on allocate nancial resources. public health will reduce from its current proporon. However, because of the focus on resource usage and The recently developed Rural Health Services Cosng allocaon, the health sector will be beer placed to Model provides insight to decision makers about the ensure the contribuons of these valued partners will opportunity costs of dierent nancial allocaon be spent accountably and more eecvely. choices. The dramac increase in populaon expected over the The resources required to obtain one outcome can life of this Plan will demand a signicant increase in then be compared with those required to achieve resources. The health sector must connually make another. Every choice to spend money for one purpose the case through advocacy, and via tangible results, means there is less available for a dierent purpose. 42 | Government of Papua New Guinea Chapter 6 Financing the Health Sector Volume 1 | Policies and Strategies that investment in health by the Government of PNG Funding from health insurance to pay for the health care is a worthwhile and frui_ul investment. A healthy of the formal sector employees will ease the burden populace is a prerequisite to achieving the aspiraons of the government in meeng the health care needs contained within Vision 2050. of the populaon of PNG. In essence this will mean that the government’s scarce resources for health can The health sector will also improve its relaonship be used to pay for health care for the rural majority with private-sector partners, parcularly with those of the populaon and the urban disadvantaged. It will resource and agribusiness companies that are allow those who have the ability to pay for their health providing health care to their employees and their care to do this through a viable health insurance families. Partnerships such as these will be leveraged scheme that will eventually be adopted by the PNG to take the pressure o public expenditure on health, Government. and to foster innovave service delivery models. The sector will also consider invesng in public–private Health insurance can be supported through a policy partnerships to deliver large-scale infrastructure framework, as well as through supporng legislaon. programs, in line with Government of Papua New The government is serious about the policy aspects of Guinea policy. At the same me, development of harnessing health insurance as a health care nancing public–private alliances will be pursued, and those opon. In 2005, NEC through its Decision No: 282/2005 crical exisng relaonships — especially with Church and Meeng No: 57/2005 approved the policy as part Health Services — will be strengthened. Opportunies of the revenue budget iniave. The NEC decision for mobilising resources for health from exisng was expected to be implemented jointly by the avenues will also be pursued. In parcular, more Department of Labour and Industrial Relaons and the eorts will be made to ensure that District Service Department of Health. The NEC Decision called for the Improvement Funds are spent on health. implementaon of a proposed compulsory employer- sponsored naonal health insurance scheme. Alternative Health Care Financing A Task Force was set up to oversee the implementaon The Government of PNG is the major nancier as well of this NEC Decision, assisted by a private consultant. as provider of health services in PNG. The churches However, the implementaon was not realised at that also contribute about 50% of health service delivery me. There is currently strong polical support and in rural areas. However, it must be noted that church commitment for this outstanding NEC Decision to be health services in PNG are mainly supported by the re-acvated. GoPNG with annual grants for both operaonal and stang grants. Currently the government, through general taxaon, nances health services in PNG. However, this source of funding for health is declining not only in real terms, but has also declined as a proporon of total government expenditure over the last three decades. The current high populaon growth rate of 2.7% per annum has placed undue demands on exisng health resources, in parcular health nancing. The government is therefore looking at alternaves for health care nancing in PNG. One of these opons is health insurance. Currently health insurance in PNG is private and voluntary, and the market size for it is small. However, the demand for private health care is increasing and this has created the need or potenal for using health insurance as an opon for health care nancing. This has been documented in several studies on health insurance that were conducted in PNG. Chapter 6 Financing the Health Sector Government of Papua New Guinea | 43 Naonal Health Plan 2011 2020 44 | Government of Papua New Guinea Chapter 6 Financing the Health Sector Volume 1 | Policies and Strategies Chapter 7 Cost of the Plan This secon provides background to the cosng of the Individual program intervenons are covered as they Plan. It is an aggregate esmate of the health sector form part of the package of services. Apart from general spending requirements for the next ten years. outpaents, inpaents, and maternity services, which are the main service capacity drivers, using more than Approach 70% of facility capacity, the costs of immunisaons, TB, HIV/AIDS, safe motherhood, child health, and malaria The approach to the cosng has been to: intervenons have been specically captured in terms • Capture the current cost of the PNG health system of their supplies/commodity requirements. based on the Medium Term Expenditure Framework Three key sources of evidence to ensure the (i.e. what does the health sector cost now?). robustness of the NHP cosng have been the Rural • Esmate the likely cost of the intervenons Health Cosng Model (developed in partnership with proposed in the Plan. Monash University and the Asian Development Bank), the Medium Term Expenditure Framework for the • Project the potenal availability of funds — Health Sector, and the Naonal Economic and Fiscal Government and Development Partners — for the Commission (NEFC) cost of services study. health sector over the period. With the help of these, a picture of a base year (2010) Cosng was done by service level, and looking at the was developed from which to add projected costs of cost of delivering a package of services to a given addional acvies contained in the Plan, and thereby populaon in an integrated manner, as opposed to the addional costs required to fund the NHP. Data cosng out individual programs. Thus costs were on current and past services, the number of units and esmated for the major capacity inputs required to sta for the dierent levels was obtained from the enable health facilies to provide services to a given Naonal Health Informaon System. populaon, including the inputs of health service sta, medical supplies, operaonal funds, and infrastructure in terms of buildings and equipment. Chapter 7 Cost of the Plan Government of Papua New Guinea | 45 Naonal Health Plan 2011 2020 Figure 24 Costing of the National Health Plan 2011–2020 by Capacity Inputs and Levels 2010 2011–2015 2016–2020 2011–2020 Capacity Inputs and Service Levels Base Per Per Per (K'million) year Total year Total year Total year Personnel Rural Health Services 150 865 173 1,050 210 1,916 192 General Hospitals 172 863 173 950 190 1,813 181 Pre-Service Training 16 91 18 109 22 200 20 Central 33 167 33 169 34 336 34 Total 371 1,986 397 2,279 456 4,265 426 Medical Supplies Rural Health Services 82 530 106 689 138 1,218 122 General Hospitals 47 261 52 305 61 567 57 Populaon Supplies (LLINs, condoms) 20 93 19 96 19 188 19 Total 149 884 177 1,090 218 1,973 197 Operating Costs Rural Health Services 80 559 112 699 140 1,258 126 General Hospitals 62 437 87 760 152 1,197 120 Pre-Service Training 1 6 1 7 1 13 1 Central 239 1,047 209 1,044 209 2,091 209 Total 382 2,049 410 2,509 502 4,559 456 Capital Rural Health Services 390 78 64 13 454 45 Rural Water Supply 22 108 22 108 22 215 22 General Hospitals 1 1,249 250 1,376 275 2,625 262 Pre-Service Training Central 32 6 48 10 79 8 Total 22 1,778 356 1,595 319 3,374 337 Total expenditure requirements 925 6,697 1,339 7,473 1,495 14,170 1,417 Funding GoPNG [ppropriaons 631 3,156 631 3,156 631 6,313 631 Development Partner Funding 294 1,468 294 1,468 294 2,936 294 Total Funding Available 925 4,624 925 4,624 925 9,249 925 Funding Shortfall 2,073 415 2,849 570 4,921 492 46 | Government of Papua New Guinea Chapter 7 Cost of the Plan Volume 1 | Policies and Strategies Main Capacity Inputs and Of the total funds available — in parcular from Service Levels Development Partners — K206m has not been possible to capture in the cosng (see Figure 25 for The cosng was organised on the basis of the following a breakdown). This amount is part of the K239m main capacity inputs. that appears as Central level operang costs10 and Recurrent Costs: represents various specic program support and overhead costs, and discrete project funding, including • Personnel ongoing capital projects. These currently available • Medical supplies funds are thus re ected as cost requirements, assuming these costs are required in the Plan period, • Operang costs (operaon and maintenance). although in a cost neutral manner, as they have not Capital Costs: been part of the deliberate cosng of requirements. • Buildings Main Cost Intervention Areas • Medical and general equipment (including The NHP cosng re ects three main cost intervenon transport) areas (in order of priority): • Long-term training (HR development plan not yet • Rural health services improvement available). • Strategic hospital improvement The service levels were also used to organise the data: • Other hospital improvement. • Rural health services • Provincial general and naonal referral hospitals • Central level, including pre-service training, central program support (M&E, IEC, research, administrave services/overheads), including specialised support services such as the CPHL/laboratory network. Figure 25 Program Support Program Support (K'million) 2010 11 Global Funds for Malaria, HIV/Aid, TB 54 12 AusAID 95 13 NZAID 14 UN agencies (UNICEF, WHO, UNFPA) 26 ADB 12 GoPNG Development budget (Torres Strait health issues) 5 Total non-costed program support 206 10 The remaining central level operang costs are represented by the NDoH G&S, excluding medical supplies 240 appropriaons in 2010. 11 Global Funds: Sta employment, training, M&E, TA, various administrave overheads, excluding medical supplies. 12 AusAID: Non-medical supplies, Malaria and AIDS support, WHO, Clinton Fund, STI clinics, medical school, IMR, TA, excluding pooled funds. 13 NZAID: including various NGO support, excluding pooled funds. Chapter 7 Cost of the Plan Government of Papua New Guinea | 47 Naonal Health Plan 2011 2020 Figure 26 Costing of the National Health Plan 2011–2020 by Main Cost Intervention Areas Cost 2011–2015 2016–2020 2011–2020 Intervention Areas (K'million) Total Per year Total Per year Total Per year Recurrent 4,512 902 4,512 902 9,024 902 Public expenditure in the health sector Capital 112 22 112 22 225 22 in 2010 Total 4,624 925 4,624 925 9,249 925 Additional costs Recurrent 297 59 921 184 1,218 122 Rural health services Capital 385 77 60 12 445 44 improvement Total 683 137 980 196 1,663 166 Strategic hospital Recurrent 34 7 257 51 292 29 improvement Capital 863 173 41 8 904 90 Total 897 179 298 60 1,195 120 2nd phase PGH; Recurrent 75 15 188 38 263 26 PMGH; ICT Capital 418 84 1,383 277 1,801 180 Total 493 99 1,570 314 2,063 206 Total Health Recurrent 4,919 984 5,877 1,175 10,797 1,080 Expenditure Capital 1,778 356 1,595 319 3,374 337 Total 6,697 1,339 7,473 1,495 14,170 1,417 Rural Health Services The addional cost requirements for rural health Costs are linked with actual service outputs and the services improvement builds on the following required resources calculated to deliver targeted levels intervenons: of service provision to the populaon, with an annual • Adequate medical supplies in the facilies. growth of 2.7% built into the cost projecons. Costs are esmated for running rural health services with • Adequate operaonal funding reaching facilies for appropriately resourced health facilies (operang at operaons and outreach. minimum standards) if a package of improved service • Beer use and distribuon of health sta. targets was being delivered. • Rural Health Services building upgrades and The RHS cost study indicated wide variaons in sta rehabilitaon and equipment replaced to minimum producvity, and suggested there is in most areas standards. capacity for increased service delivery using present stang levels, although increases in stang levels will • Improvements to Central Public Health Laboratory be required to provide for an increasing populaon in (CPHL) and rural laboratory network. the future. The study also showed signicant decits • Community Health Posts trial in ve provinces. in spending on infrastructure and equipment, and medical supplies. The cost esmates take into consideraon that overall increases in services per populaon as a result of these Service delivery would also be improved immensely intervenons are expected to reach 2004 levels by with further operaonal funding available at health 2015, or increase of general service volumes compared centre level, parcularly to cover transport and other with current service provision by up to 40%14. costs, which can be used to improve the low level of outreach services currently being undertaken by health centres. 48 | Government of Papua New Guinea Chapter 7 Cost of the Plan Volume 1 | Policies and Strategies Hospital Sector • Port Moresby General Hospital redevelopment. It is expected that beer performing and resourced • Pacic Medical Centre. rural and district health services, able to achieve beer outcomes in prevenve services and early • ICT development. intervenon, will lead to reduced overall load on the During the process of cosng the NHP, certain key hospital sector. messages have impressed themselves repeatedly: Analysis of lengths of stay overall, as well as for • Signicant improvements in the health sector can similar clinical groups, shows a considerable variaon be made without necessarily needing more money. between hospitals, ranging generally from 6 days up to 16 days per admied paent. This indicates that • Eciency gains can readily be achieved in both rural there is in most areas sucient available capacity health services and hospital services. for increased service delivery, using present stang • The health sector should be achieving beer levels. In addion, reducing the burden of just three outcomes with exisng levels of sta. signicant infecous diseases (malaria, pneumonia, and tuberculosis) can be expected to signicantly • Drugs and supplies are a key blockage to service reduce hospital admissions, and in turn hospital bed improvement. days. • The availability of operaonal funding at the facility Addional cost requirements for strategic hospital level is a key blockage to service improvement. improvement include: The following diagram shows the funding gaps • Enhancement of four hospitals to strengthen between projected esmates of funding availability regional services (Health Vision 2050 iniave, and the major cost intervenon areas. The major cost including Mount Hagen, Angau, and Nonga), and intervenons are arranged in an accumulave way, increase in their recurrent resources by 20%. such that strategic hospital improvement includes rural health services improvement. • Resources for Master Planning for Port Moresby. The current (2010) health share of the overall GoPNG • Resources for emergency minor works in all recurrent budget is about 16%. Provided the health provincial hospitals. share of the overall GoPNG recurrent budget remains • Redevelopment (capital works program) for Angau, constant at 16% over the NHP period, then about Kerema, Goroka, and Nonga provincial general half of the addional costs required for rural health hospitals. services improvement can be covered15, and this will need to increase to 18% to cover the addional rural Addional cost requirements for second phase health services improvement costs fully (assuming DP improvement of provincial general hospitals and Port funding remains at current levels). Moresby based development includes: Funding of all cost intervenons, i.e. total health • Enhancement of two district hospitals to provincial expenditure over the NHP period of K14.1 billion, hospital standards (for Jiwaka and Hela). will require 27% of overall GoPNG recurrent budget • Redevelopment (capital works programs) for Boram, be allocated to health (again assuming DP funding Kavieng, Popondea, Wabag, and Daru provincial remains at current levels). general hospitals; and construcon of a new Central provincial general hospital. 14 Represented by outpaent services: current (2008) outpaents per capita is 1.37 (total 8.9m) against 1.54 in 2004 (total 8.9m). With a general annual populaon growth of 2.7%, 1.54 outpaents per capita will translate into more than 12m outpaent services provided in 2015. 15 Refer to projecons from Treasury budget outlook for 2010. Chapter 7 Cost of the Plan Government of Papua New Guinea | 49 Naonal Health Plan 2011 2020 Figure 27 Current Funding (including Government and Development Partners) PNG Appropriations (K’million) 2010 Recurrent expenditure 619 Capital/Development 12 Total PNG [ppropriaon 631 Development Partners (K’million) 2010 Development Partner 207 Global fund (HIV/Aid, TB, Malaria) 87 Total Development Partner 294 Total Funds available (K’million) 925 Figure 28 Projected Expenditure on Health over the Life of the Plan Projected Expenditure on Health Over the Life of the Plan 1,700 All Projected Annual Expenditure (Kina Millions) 1,600 1,500 Strategic hospitals 1,400 1,300 Rural Health Services 1,200 1,100 1,000 Health share of GoPNG recurrent budget remain 900 constant 800 Real spending on health 700 remain at 2010 levels 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 50 | Government of Papua New Guinea Chapter 7 Cost of the Plan Volume 1 | Policies and Strategies Chapter 8 Performance Monitoring Framework The performance monitoring framework for the How Do We Measure Performance? Naonal Health Plan will provide a guide to measuring Each Key Result Area has objecves, in addion to progress towards the agreed targets. It sets out what the global aim of achieving beer health for PNG. will be measured and when it will be measured. Indicators have been selected that provide for regular review of whether these objecves are likely to be Why Monitor and Measure Health achieved. These indicators are brought together into Sector Performance? a Performance Assessment Framework (PAF), which Planning is about achieving results. From the will inform the development of the Performance community, right through to the highest levels of Monitoring Plan. the health sector, all want to see improvements The PAF provides the key guide to measuring progress in performance and realisaon of the goals and towards the agreed targets, including what will be objecves of the Plan. measured and when it will be measured. The PAF The purpose of monitoring is to improve the includes a limited number of indicators that provide performance of the health sector. It is a part of the an overall assessment of services. These indicators management process, and focuses implementaon measured on an annual basis are relevant to NDoH with the overall goals and objecves in mind. There Provincial and District Health Oces, and examine are several reasons for measuring health sector and approaches that are under the direct control of the system performance, including to: sector. Each program and province will have more detailed indicators to explore implementaon at a • Develop policies, strategies, and plans. deeper level. • Evaluate specic intervenons (for example, the impact of IMCI). • Generate knowledge and comparisons (for example, between districts and provinces, and internaonal reporng). Chapter 8 Performance Monitoring Framework Government of Papua New Guinea| 51 Naonal Health Plan 2011 2020 Who Receives the Performance Data collecon systems will be supported through Monitoring? adequate training and supervision, independent assessment of data quality, and the capacity of systems Most importantly, performance monitoring provides to provide disaggregated and resourceful informaon. informaon to managers at each level of the health Appropriate data governance systems are to be system. There are also reporng obligaons. established to ensure data quality. The Naonal Health Administraon Act 1997 states The health informaon system will be further that monitoring is the responsibility of the Naonal integrated into exisng provincial accountability and Provincial Health Boards and District Health mechanisms, facilitated through the Department of Commiees. The Naonal Health Board is required to Provincial and Local Government Aairs (DPLGA), report to the Minister for Health. The Minister reports through the Provincial and Local Level Services annually to Parliament. The sector is also required by Monitoring Authority (PLLSMA). This will be primarily central agencies to report on progress towards the achieved by incorporang the PAF indicators into the internaonally agreed Millennium Development Goals, Secon 119 reporng for the health sector. This is and the Papua New Guinea Development Strategic expected to further enable the health sector to engage Plan 2010–2030. The Health Sector Improvement provincial administraons to beer understand Program (HSIP) requires that progress towards agreed and appreciate health sector performance issues. goals and targets is documented on a regular basis Provincial Administrators will have the opportunity to with development partners. respond to health issues from an informed basis. The Performance Assessment Framework is a single The success of the performance assessment will instrument that provides the necessary reporng come from its ability to lead to strengthened capacity on the Naonal Health Plan, and also meets these to achieve results. Regular performance analysis is broader reporng requirements. crical for achieving this. Therefore, it is expected that quarterly reviews examining detailed performance How Will It Operate? data will be undertaken within provinces and at a There are three sources of data available to measure naonal program level. On an annual basis a report inputs and results: against the indicators of the PAF will be published, providing a sector-wide snapshot of naonal and • Facility and service data, most commonly collected provincial progress toward goals and targets. The through the Naonal Health Informaon System report will provide performance informaon by (NHIS), and providing informaon about acvity province, and will facilitate further discussion on how and morbidity. to adapt planning to meet needs where eecveness • Administrave and management records and is reduced. reports, which provide informaon about inputs This Plan is also proposing to establish a Naonal Public into the sector (for example, nancial and human Health Instute that will, when operaonal, provide resources, and supervision). further objecve monitoring of the health sector and • Household surveys, which provide informaon promote dialogue on emerging health challenges. about coverage, determinants of health, and mortality. The DHS and other roune community What Will Be Measured? surveys serve this need. The PAF denes a set of indicators across each Key Result These sources collecvely provide informaon on Area. There are several higher level indicators that the performance and improvements in health service provide measures of longer-term gains. The indicators delivery, and also provide informaon on why certain listed below are supported by detailed descripon of areas may not be improving. By simultaneously measurements, data sources, and responsibility. A full considering informaon on expenditures and list of annual indicators can be found in Annex 2. It performance of service delivery, management will be is expected that these will be rened and be agreed able to respond to performance shortcomings. prior to the rst reporng period in 2012, and then incorporated into the Performance Monitoring Plan. The quality of data will accurately depict performance achievements, and also insl condence in the ability to monitor performance. 52 | Government of Papua New Guinea Chapter 8 Performance Monitoring Framework Volume 1 | Policies and Strategies Figure 29 Impact Indicators Indicators Frequency Maternal Mortality > o 5 years Childhood mortality: ~ Neonatal Mortality Rate 5 years ~ Infant Mortality Rate ~ Under-5 years Mortality Rate Proporon of   with access to improved water source and    facility 2 years  <  Prevalence Rate 5 years Figure 30 Review Schedule Review Type Frequency Health Sector Reviews Annual Mid-term Review 2016 Final Review (including lessons learned) 2019 Formulaon of next ten-year NHP Starng 2019 Provincial level indicators will be developed in line with naonal targets, following the launch of the Plan. These will be considered for incorporaon into provincial Secon 119 reporng. When Will It Be Measured? The broad accountability framework for health services delivery in PNG will be based on one health strategy — the Naonal Health Plan — and its validaon process. Partners in health will parcipate in the development, review, approval, and use of the PAF. To this eect, all partners to the sector will parcipate in joint annual performance reviews, mid-term reviews, and evaluaons of the Naonal Health Plan. Evaluaon of the Naonal Health Plan will be undertaken at mes deemed suitable and in response to the annual reports of the PAF. To the extent possible, the use of addional or separate performance reviews and indicators will be phased out. Informaon on program progress will be gained through an independent joint periodic review that meets the needs of government and development partners, assessing the informaon gleaned through the PAF, and probing deeper into the achievements and problems faced by front-line management and service delivery sta. Chapter 8 Performance Monitoring Framework Government of Papua New Guinea | 53 Naonal Health Plan 2011 2020 54 | Government of Papua New Guinea Chapter 8 Performance Monitoring Framework Volume 1 | Policies and Strategies Annexes 1. Development and Consultaon Process for the Plan 2. Annual Reporng Indicators 3. Lists Annexes Government of Papua New Guinea | 55 Naonal Health Plan 2011 2020

Annex 1 Development and Consultation Process for the Plan The development of the Naonal Health Plan 2011–2020 was dierent to previous plans. This is because the Senior Execuve Management (SEM) and Naonal Health Plan Secretariat put in place a communicaon strategy and provided wider consultaons to our stakeholders, partners, and implementers during the process of developing the NHP. The consultaon process was coordinated and managed by NHP Secretariat in the Strategic Policy Division. Stakeholders and Partners in Consultation Representatives Minister for Health and HIV/AIDS: • NEC endorsed the development of the NHP 2011–2020 Service delivery to the rural majority and the urban • Minister briefed at every stage of development. disadvantaged PRIMARY HEALTH CARE Secretary for Health and Milne Bay nurses at the POLITICAL COMMITMENT AND SUPPORT southern region NHP consultaon workshop, Alotau. Naonal Health Plan Commiees: • Technical Advisory Group (TAG) • Steering Commiee (SC) • Naonal Health Plan Secretariat. WE CARRY OUT THE DIRECTIONS FROM SEM Naonal Health Plan Secretariat 56 | Government of Papua New Guinea Annexes Volume 1 | Policies and Strategies Stakeholders and Partners in Consultation Representatives Senior Execuve Management (SEM): • Conducted brieng and consultaon meengs • Provided guidance and direcons during dierent stages of developing the NHP. SETTING POLICY AND STANDARDS AND PROVIDING SEM members at Madang Consultaon Workshop DIRECTIONS IS OUR BUSINESS Steering Commiee and Technical Advisory Group: • Provided direcon, technical advice, and feedback on the dierent stages of the development and nalisaon of the Naonal Health Plan. PROVIDING GUIDANCE IS OUR RESPONSIBILITY TAG and SC commiee members Naonal Health Conference, June 2009: • The Naonal Health Conference in Goroka debated themac papers on a priority framework and feedback was received, which has formed the basis for the priories of the Naonal Health Plan 2011– 2020. Naonal Health Conference parcipants, Goroka Annexes Government of Papua New Guinea | 57 Naonal Health Plan 2011 2020 Stakeholders and Partners in Consultation Representatives Naonal Department of Health Workshops 1, 2 & 3: • Brainstorming and program and performance review feedback. • Development of Themac Framework for June 2009 Naonal Health Conference. • Provided feedback on the rst working dra of NHP. MONITORING IMPLEMENTATION OF POLICY AND STANDARDS IS OUR BUSINESS. Central Agencies: • DPLG, DNPM, Treasury, PM Department, DPM, Educaon, Community Development, PLLSMA were all consulted. HEALTH CANNOT DO IT ALONE, WE NEED YOUR SUPPORT Provinces, Hospitals and Districts: • Four Provincial and Regional Consultaon Workshops conducted. • One naonal consultaon and reviewed and provided feedback on the rst working dra of the NHP. • Provinces, Hospitals, and Districts provided feedback during the dierent stages of the development of the NHP. IMPLEMENTATION AND REPORTING IS OUR BUSINESS PHA, Hospital CEO, PA, DA, DHM 58 | Government of Papua New Guinea Annexes Volume 1 | Policies and Strategies Stakeholders and Partners in Consultation Representatives Churches and Non-Government Organisaons: • Parcipated at the Regional Workshops and Naonal Workshop and provided feedback on the rst working dra. • They are our major partners in providing health services to the rural majority and their contribuon and feedback during dierent stages was very important in framing the NHP for the people of PNG. TOGETHER WE WILL MAKE A DIFFERENCE Church Health Secretaries, Pathnder Internaonal, Family Health Associaon Training Instuons: • Universies, Nursing colleges and Community Health Worker Training Schools, Deans and Principals were consulted and feedback received at every stage of developing the NHP. WE WILL PRODUCE WORKFORCE REQUIREMENTS Health workers parcipang in NHP Workshop Alotau, MBP Development and Donor Partners: WE NEED YOUR SUPPORT Annexes Government of Papua New Guinea | 59 Naonal Health Plan 2011 2020 Stakeholders and Partners in Consultation Representatives District Consultaon Workshop: • A two-day workshop was conducted for District Administrators, District Health Managers, and Provincial Health Advisers to communicate and provide feedback on the NHP. IMPLEMENTING NATIONAL AND PROVINCIAL District Administrators, District Health Managers POLICIES, STANDARDS, AND GUIDELINES IS OUR BUSINESS Public Awareness and Radio Talkback: • Radio Talkback by the Secretary and SEM • Opinion box distributed to province Radio Spot in NBC and Wantok Radio HEALTH COMMUNICATION IS OUR BUSINESS Radio talkback show at NBC 60 | Government of Papua New Guinea Annexes Volume 1 | Policies and Strategies Stakeholders and Partners in Consultation Representatives Wider Consultaon: All of us are the implementers of the Naonal Health Plan 2011–2020. The Department of Health undertook wider consultaon with health professionals, the general public, and our stakeholders. Thank you all for your parcipaon in this very important iniave. NCD and Central Parcipants SECURING A HEALTHY FUTURE FOR THE PEOPLE OF PAPUA NEW GUINEA IS OUR BUSINESS Annexes Government of Papua New Guinea | 61 Naonal Health Plan 2011 2020

Annex 2 Annual Reporting Indicators It is important to note that these will be rened further as part of the development of the Performance Monitoring Plan. Indicator Key Result Program Indicator Number Area Proporon of rural outreach clinics per   under 5 1a years. Access to 1b Proporon of aid posts that are open. services Proporon of districts with Community Health Posts # er 1c their development). Service Facility Proporon of health centres that have received at least one 2 Delivery supervision and supervisory support visit from District and/or Provincial support management st  during the year. Proporon of general hospitals (PMGH and the provincial 3 Curave services hospitals) that have at least three of the ve key speciales. Service Proporon of health centres/hospitals with < 4 infrastructure radio/telephone. Proporon of provinces that have established service level 5a Partnerships Service agreements with church and non-government or   and agreements Number of  onal service level agreements with 5b <$  church and non-government    General expenditure (health func  grants and HSIP) at Provincial 6 district/facility level as a percentage of total provincial nancing expenditure on health. Density of paediatric-trained nurses (per 10,000 of 7a  " Health 7b Density of midwives (per 10,000 of  " systems and Health governance workforce Total number of paediatricians in clinical and public health 7c segs. Total number of obstetricians in clinical and public health 7d segs. Percentage of months that facilies have all key medical 8 Medical supplies supplies. 9a Proporon of 1-year-old children immunised against measles. mmunisaon coverage Proporon of 1-year-old children vaccinated with three doses 9b DTP-HepB-Hib pentavalent vaccine. 10 Nutrion Prevalence of underweight children under 5 years of age. Child health Case fatality rate for pneumonia in children under 5 years in 11a hospitals. Case fatality Case fatality rate for pneumonia in children under 5 years in 11b health centres. Proporon of neonates that are < ed as having low birth 12 Neonatal health weight. 62 | Government of Papua New Guinea Annexes Volume 1 | Policies and Strategies Proporon of pregnant women who receive any antenatal 13 care. Safe 14 motherhood Proporon of births aended by skilled health personnel. Maternal 15 Health Referral rate for emergency obstetric support. 16a Couple years of protecon. Family planning 16b Contracepve acceptor rate. 17a Disease Malaria Number of reported cases of malaria. Control preenon and Proporon of children under 5 years sleeping under 17b treatment inseccide-treated bed nets. Annexes Government of Papua New Guinea | 63 Naonal Health Plan 2011 2020

Annex 3 Lists Abbreviations AAP Annual Acvity Plan AP Aid Post ARV Anretroviral CHP Community Health Post CHW Community Health Worker CMH Commission on Macroeconomics and Health CPHL Central Public Health Laboratory DHS Demographic and Health Survey 2006 DNPM Department of Naonal Planning and Monitoring DSIP District Service Improvement Program DTPw-HB/Hib Diphtheria-Tetanus-whole cell Pertussis-Hepas B/Haemophilus In uenza Type B EOC Emergency Obstetric Care GDP Gross Domesc Product GoPNG Government of Papua New Guinea HC Health Centre HIV and AIDS Human Immunodeciency Virus and Acquired Immune Deciency Syndrome HRIS Human Resource Informaon System HSIP Health Sector Improvement Program IBRD Internaonal Bank for Reconstrucon and Development ICT Informaon Communicaon Technology IMCI Integrated Management of Childhood Illness IT Informaon Technology JPPBPC Joint Provincial Planning and Budgets Priories Commiee KRA Key Result Area LLG Local Level Government LLIN Long Life Impregnated Nets LNG Liquid Natural Gas LTDS Long Term Development Strategy (now PNG Development Strategic Plan 2010–2030) MDG Millennium Development Goal MDR-TB Mul-Drug Resistant Tuberculosis MTEF Medium Term Expenditure Framework NAC Naonal AIDS Council 64 | Government of Papua New Guinea Annexes Volume 1 | Policies and Strategies NDoH Naonal Department of Health NEFC Naonal Economic and Fiscal Commission NHAA Naonal Health Administraon Act 1997 NHIS Naonal Health Informaon System NHP Naonal Health Plan NGO Non-Government Organisaon NIHF Naonal Inventory of Health Facilies OECD Organisaon for Economic Cooperaon and Development PAF Performance Assessment Framework PCMC Provincial Coordinaon and Monitoring Commiee PEP Post Exposure Prophylaxis PHA Provincial Health Authority PHAA Provincial Health Authories Act 2007 PHC Primary Health Care PHO Provincial Health Oce PLLSMA Provincial and Local Level Service Monitoring Authority PMGH Port Moresby General Hospital PNG Papua New Guinea PNG DSP Papua New Guinea Development Strategic Plan 2010–2030 (previously LTDS) PPP Public–Private Partnership PPTCT Prevenon of Parent-to-Child Transmission STI Sexually Transmied Infecon SWAp Sector-wide Approach TB Tuberculosis TB DOTS Tuberculosis Directly Observed Treatment, Short-course UN United Naons USD United States Dollar VHV Village Health Volunteer WHO World Health Organizaon Annexes Government of Papua New Guinea | 65 Naonal Health Plan 2011 2020 Denitions Burden of disease The impact of a health problem in an area, measured by nancial cost, mortality, morbidity, or other indicators. Case fatality rates The rao of deaths within a designated populaon of people with a parcular condion, over a certain period of me. Central Agencies Government of PNG Core Departments, which includes Department of Treasury, Department of Finance, Department of Naonal Planning and Monitoring, Public Sector Management Reform Unit, and Department of Provincial Local Government Aairs. Child Mortality Rate (CMR) The number of children under ve years of age dying per 1,000 live births in a given year. Also known as the Under-Five Mortality Rate. Child survival A eld of public health concerned with reducing child mortality. Child survival intervenons are designed to address the most common causes of child deaths that occur, which include diarrhoea, pneumonia, malaria, and neonatal condions. Determinants of health The range of personal, social, economic, and environmental factors that determine the health status of individuals or populaons. Essenal medical supplies Those that sasfy the priority health care needs of the populaon. They are selected with due regard to public health relevance, evidence on ecacy and safety, and comparave cost-eecveness. They are intended to be available within the context of funconing health systems at all mes in adequate amounts, in appropriate dosage forms, with assured quality and adequate informaon (WHO). Exclusive breas_eeding ‘An infants’ consumpon of human milk with no supplementaon of any type (no water, no juice, no nonhuman milk, and no foods) except for vitamins, minerals, and medicaons’ (American Academy of Pediatrics). Health indicators Measures that re ect or indicate the state of health of a certain group of persons in a dened populaon. Healthy Islands A healthy island is one that is commied to and involved in a process of achieving beer health and quality of life for its people, and healthier physical and social environments in the context of sustainable development. Health nancing How nancial resources are generated, allocated, and used in health systems. Examples of health nancing issues include: (i) how and from where to raise sucient funds for health; (ii) how to overcome nancial barriers that exclude many poor from accessing health services; or (iii) how to provide an equitable and ecient mix of health services. Health outcomes The eect on health status from performance (or non-performance) of one or more processes or acvies carried out by health care providers. Health outcomes A change in the health status of an individual, group, or populaon, which is aributable to a planned intervenon or series of intervenons, regardless of whether such an intervenon was intended to change health status. Health promoon The process of enabling people to increase their control over and to improve their health. 66 | Government of Papua New Guinea Annexes Volume 1 | Policies and Strategies Health services All services dealing with the diagnosis and treatment of disease, or the promoon, maintenance, and restoraon of health. They include personal and non-personal health services. Health system A health system is the sum total of all the organisaons, instuons, and resources with the primary purpose of improving health. Health workers ‘All people engaged in acons whose primary intent is to enhance health’ (World Health Report 2006). Infant Mortality Rate (IMR) The number of children dying under one year of age, divided by the number of live births that year. The infant mortality rate is also called the infant death rate. Maternal Mortality Rao (MMR) Number of women dying of pregnancy-related causes out of 100,000 live births in a given year (ODI/HPN paper 52, 2005, Checchi and Roberts). Neonatal Mortality Rate (NMR) Number of deaths during the rst 28 completed days of life per 1,000 live births in a given year or other period. Also known as the neonatal death rate. Non-communicable diseases Diseases that are not contagious, but may be acquired through a person’s lifestyle, genecs, or environment. Primary health care Oen abbreviated as PHC, primary health care is: ‘Essenal health care based on praccal, sciencally sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full parcipaon and at a cost that the community and the country can aord to maintain at every stage of their development in the spirit of self-determinaon’ (Alma Ata internaonal conference). Private health care providers Organisaons providing health services that are not part of government. Public health Public health is a social and polical concept aimed at the improving health, prolonging life, and improving the quality of life among whole populaons, through health promoon, disease prevenon, and other forms of health intervenon. Public–Private Partnership (PPP) A method to procure and deliver infrastructure and services through cooperaon between a public instuon and one or more private enterprises. Annexes Government of Papua New Guinea | 67 Naonal Health Plan 2011 2020 Figures Figure 1 Linkages between the NHP and GoPNG Vision 2050 Pillars Figure 2 Intersecon of NHP Objecves with PNG DSP Key Health Targets Figure 3 Health Sector Planning within Whole-of-Government Planning Figure 4 Intersecons of NHP Objecves with Millennium Development Goals Figure 5 Indicators of PNG Health and Development Status Figure 6 Internaonal Comparisons Figure 7 Mortality Rates for Under-Fives Figure 8 Infant and Child Mortality Figure 9 Admissions Figure 10 Outpaent Visits Figure 11 Malaria Admissions Figure 12 HIV Diagnoses Figure 13 Childhood Mortality Distribuon Figure 14 Outreach Visits Figure 15 Medical Supplies at Facilies Figure 16 Ageing Workforce Figure 17 Expenditure — Internaonal Comparisons Figure 18 Focus Areas of the Naonal Health Plan 2011–2020 Figure 19 Health Vision 2050 Figure 20 Health Vision 2050 — Implementaon Schedule Figure 21 Recurrent Expenditure — Rural and Hospital Services 2007–2010 Figure 22 Goods and Services, excluding Medical Supplies — Rural Health Services (NEFC cost esmates) Figure 23 Distribuon of Health Services and Resources Per Capita by Provinces Figure 24 Cosng of the Naonal Health Plan 2011–2020 by Capacity Inputs and Levels Figure 25 Program Support Figure 26 Cosng of the Naonal Health Plan 2011–2020 by Main Cost Intervenon Areas Figure 27 Current Funding (including Government and Development Partners) Figure 28 Projected Expenditure on Health over the Life of the Plan Figure 29 Impact Indicators Figure 30 Review Schedule 68 | Government of Papua New Guinea Annexes Volume 1 | Policies and Strategies Annexes Government of Papua New Guinea | 69 Secretary for Health, National Department of Health PO Box 807, Waigani NCD, Papua New Guinea