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    Papua New Guinea Health Practice Memorandum

    Papua New Guinea (PNG) currently uses health care system provided by the Government of PNG, the Churches in PNG and the Non-Governmental Organisations (NGO). In addition to this, there are 15 to 20 private operating health facilities. They are funded by sources of tax revenues, Donors, and the users. Currently, PNG uses 3.6 percent of its GDP over the healthcare system of the country. Whereas, 20 percent of the utilized funds are procured from the donors and the rest of the funds are procured from the service users of the patients. 
    The availability of the doctors is as low as one per 17068 people. In addition to this, they are ineffectively distributed. Whereas 85 % of the population resides in the rural part of the country the number of physicians is only 51. As per WHO records there are about 5.3 nurses per 10000 populations. The workforce is characterized by a low number of staffs who are demotivated with poor working conditions and low wages. The training of the staffs is insufficient and they are distributed inefficiently across the clinics. 30 percent of the skilled staffs are occupied in administration and management positions which render the services ineffective. 
    The healthcare delivery is challenged by geographical / natural topology, cultural inconsistency, operational ineffectiveness and infrastructural inadequacy. In addition to this, there has been an increase in critical diseases. However, the challenges are more severe due to other internal and external factors including funding for the short, medium and long-term expenses. The PESTLE analysis will help to generate more critical insight into the overall challenges. 
    Political: The operational inefficiency of the national and provincial governmental bodies has resulted in unchecked criminal activities which have restricted the ease of delivery of health services. 
    Economic: The economic condition has been improving through improvement of infrastructure relative to the conditions prior to 2010. However, the GDP is an average of 4.14 percent. The minimum wage has been 140 PGK in 2017 or 55 Australian Dollars.
    Social: The current population of the PNG is 7.6 million people. The geographical boundaries have given rise to isolated clusters of villages which have developed their own lifestyle, language and social norms. Collaborating with the tribes and the technologically influenced city conglomerate. Further, this has given rise to the high volume of crimes and civil fights, hooliganism and robbery. 
    Technological: All the above factors have logically resulted in restrictions towards the development of national infrastructure required for health care. Telecommunication has seen a high development after the reforms made in 2008 through the rollout of Digicell’s network. However, the penetration remains highly restricted to 47% in wireless and 1.9 % in wired and 16% in 3g/4g services. Road transport infrastructure is limited to 25 percent of the entire road network for all season travel. The electricity demand is rising at a rate of 5.5 percent  whereas the supply is low and mostly rely on renewable sources. However, infrastructure is inadequate to suffice the demand.
    Legal: The legal scenario is strained through its civil turmoil, crime and hooliganism. Civil clashes are prevalent in the rural areas as well as in the township. Strict policing infrastructure is essential. The corruption rank is 136 is very high. 
    Environmental: Geographically, PNG is fragmented by hills, rivers and forests. The unwinding, dangerous and rocky roads make it critically challenging to lay the foundation for a solid transportation infrastructure. However, this challenge has deteriorated through cultural inconsistency that has been present through ages. 
    The other challenges are as follows: -
    The increase of cases pertaining to critical diseases like various communicable diseases, HIV epidemic, Cancer and cardiovascular diseases. The critical communicable diseases found in ONG are malaria, tuberculosis, diarrheal diseases, cholera, acute respiratory disease and the general epidemics of HIV [1, 2, and 4]. This has resulted in 62 percent of reported nationwide deaths. Further, this has been aggravated by the lack of clean water for 33 percent of the PNG population.
    Investors are further demotivated due to the high risk of operation pertaining to employee and business wellbeing. Donor’s funds are still available with the PNG government which has been utilized towards procurement of medical supplies, instruments, payment of wages, etc. However, they are highly inconsistent which results in out-of-pocket expenses for the locals who in most cases cannot afford the cost. This results in inaccessibility of the health care services.
    Due to lack of locally available specialized personnel, the cost of health care is still out of reach for the general public dwelling in the towns and rural areas. However, if specialized personnel is available from the locals spanning both towns and rural areas, then the effectiveness of service delivery can be increased even by keeping the operational costs low.  
    Health Care requirements of PNG
    The report by Dr Sultan (2015) emphasizes that the PNG healthcare infrastructure requires doctors, physicians and nurses to compensate the rather ration between the staff and the population. Till 2010 the basic necessities for medical supplies has been 60 percent at an average which has increased to 80 percent in 2011 through funding from internal and external donors. However, the clinics and provincial health centres have shortages of electricity, refrigeration and storage management for drugs. The updating of essential medical lists which has been done in 2012 and subsequently the National Drug Policy in 2014 is also required to be done periodically through a common governmental agenda. Further, it is also a critical aspect to be considered that the foreign donors especially the neighbour- the Australian government has been relied upon to consider for the medical expenses between 2014 to 2017. However, Dr Sultan finds that this will be inadequate towards the development of the country’s health system. Supporting the argument, a report from the WHO (2015) essentially establishes that a supportive Human resource for a health plan is required to be placed after their research through the Country Coordination and Facilitation (CCF) initiative in 2010.  
    According to the CCF initiative, the PNG healthcare challenges have been analyzed but has reached an operational boundary in terms of administrative issue. However, the WHO expects that the shortcomings will be overcome through the implementation of the CCF policies and procedures. The research reveals that the Human Resource for Health (HRH) plan has to follow the Human Resource management process. The process starts with HRH Coordination with the WHO. The next step will be to analyse the situation in terms of micro and macroeconomic perspectives. These perspectives will span the political, social, economic, technological, legal and environmental perspective (PESTLE). These perspectives are discussed in paragraph 3 above. This will help to develop the HRH Planning. The planning processes should incorporate the financial, administrative, infrastructure and legal aspects of deployment of the human resources. The training and development of the staffs will be critical to its success. The resource mobilization policy will enable the government to optimally place them across its provinces so that the health care system is accessible to the population. This will help to improve the health care coverage for the government. Finally, the implementation phase should be meticulously planned and the various risk factors should be considered. They will not be limited to social, environmental and geographical boundaries but should also involve the economic, cultural and language boundaries. 

    Recently, PNG has acquired a large external donor who is willing to provide the funding necessary for drug, diagnostics, food and transportation expenses for poor patients being treated in the public hospitals. This source of funding will suffice for the short, medium and long-term financial requirements to run and deliver the healthcare service for the PNG population. This will allow for procurement of more personal to reduce the staff to population ratio. Further, specialist services can be purchased for off-shore doctors and physicians. However, there are several complications in this new funding system.
    The requirement of the donor is to provide funds for the poor and who can access the services of the public hospitals. This will require intricate recording of patient data to consider for the financial support. This means that in a situation where there are cultural, social and lifestyle challenges, recording and operating on health services based on the economic condition of the population might be impossible. In addition to this, the nature of violence experienced by the locale in their daily life may instigate corruption from within. 
    The high physician and population as well as nurse and population ratio is at a critical scenario as discussed in paragraph 2 above is an evidence to the fact that the increased reliance on foreign specialities to improve the health services will increase the expectation of the population to a point of no return. For instance, in the contemporary scenario, the rural indigenous population and the economically poor class still believes the non-accessibility and non-availability of services. However, through the drastic improvement of health delivery will increase the expectations and the service requirement will increase drastically. People will tend to believe that their health services will be easily available and they can easily expect a higher mortality rate. The financial requirements will also increase exponentially. Quickly the government will have to rely on an increased number of foreign donors to cater the requirements of expenses. If the government fails to deliver the civil outbreak may be catastrophic. 
    With reference to paragraph 8 above, the possible solution is not to utilize the funds to cater to the medical needs of the poor directly but to allow the foreign donor to exercise the operational control. In other words, a partnership with the foreign donors to actively run the operation controlled by their own management where the government will have a percentage of the stakes. This means a Public Private Partnership with the private health organizations for the funding and operational requirements. This will result in the development of infrastructure, economic development for the local and the government. Further, the foreign specializations will also be available. However, the primary challenge will be the economic capacity of the majority of the population and the availability of the health centres for the majority of the indigenous population. Further, the cost of health care will also increase due to the business objectives of the private organizations.
    With reference to the argument in paragraph 9 above there is a high requirement for healthcare staffs including, physicians, specialists and nurses. Further, from the paragraph 3 above, it is clear that the social lifestyle of PNH is so diverse that to understand it there is a high need for locals to be incorporated into the health systems. From the report of Dr Sultan (2015) on the PNG health system discussed in paragraph 5 above, it is clear that investments in developing the local workforce will be far more beneficial than direct investments in funding the medical expenses for the healthcare of the economically backward population. The government also has a dire need for addressing the shortages of personnel and reducing the medical expenses. Infrastructure for healthcare education and specialized institutions to train the personnel for specialized treatment is a more pressing need. Treatment for the diverse social clusters which has been highly challenging can be addressed through patient training and development of the staffs. 
    It can be concluded that PNG has been developing relatively in terms of its infrastructure. However, the shortcomings in terms of essential infrastructure have been a major constraint for the development of the health systems. The Ministry of Health is advised to channel the funds more towards training and development of the locals for the medical needs rather than relying upon external sources.