One factor that is hindering labour productivity and long-term growth in Papua New Guinea is the poor state of public health – although the picture is slowly improving. Advancing the country’s primary health care system is a priority for both the social agenda and economic plans, with the target to achieve universal health care a key part of the Development Strategic Plan 2010-30. A number of challenges must be overcome to implement this, however, particularly widening access and improving delivery in the face of insufficient infrastructure. According to the Ministry of Health, there were two teaching hospitals, 21 provincial hospitals, 89 district hospitals and 520 clinics in PNG, as of mid-2019, for a population of roughly 8.3m. In addition, more efficient financial management and using digital administration systems for data tracking are supplementary actions that can go a long way to support health outcomes.
State of Affairs
Looking at basic health metrics, PNG has a high mortality rate and low life expectancy, but these measures are improving. According to World Health Organisation (WHO) estimates, the mortality rate dropped from 335 per 1000 of the population in 2000 to 275 in 2015, while life expectancy rose from 58 years in 1990 to 63 in 2015. Poor maternal and child health, including a high rate of chronic malnutrition, are some root causes of those figures being weaker than global averages. In a February 2018 report the World Bank stated that child undernutrition cost PNG the equivalent of 2.8% of GDP in 2016. Estimates vary, however, with UK-based consultancy Frontier Economics suggesting the figure could be as high as 8.45% per year. PNG has a young population: 36% of the country was under 15 years of age in 2015. It is therefore imperative to address health in the early years, ensuring children are able to attend and learn in school to go on to be healthy, working adults. This, in turn, will contribute to PNG’s long-term economic development.
Other challenges to public health include widespread communicable diseases – notably, tuberculosis (TB) and malaria – and a growing rate of non-communicable diseases (NCDs). Furthermore, servicing PNG is a logistical challenge, as over 80% of its population resides in rural areas, some of which are inaccessible by road. Other infrastructure challenges include unreliable electricity, which is required not only for medical equipment, but also for cold chain management – a necessity for certain medicines and vaccines. Compounding these issues is a shortage of personnel, clinics and drugs.
In theory, there is a national policy of free primary health care for all. This is largely financed by taxes, with 21% sourced through external assistance. In reality, though, informal user fees are charged due to insufficient funding or delays in disbursement. Administratively, some sector issues stem from the slow transition of responsibilities for provincial health services from the National Department of Health to the Provincial Health Authority, which combines the provincial and district health systems under one body, per a 2007 law.
Financial Considerations
According to the Department of Treasury’s “Final Budget Outcome 2018” report, health spending was PGK1.38bn ($418.6m) that year, excluding donor assistance. This is in line with the 2017 budget allocation of PGK1.3bn ($394.3m) and average of PGK1.4bn ($424.6m) in preceding years. No substantial increase in funding for the health sector is forecast for the medium term. The IMF estimates that PNG will require some $2.4bn from 2018 through to 2020 to finance its health care goals. To this end, the government requested $300m from the Asian Development Bank in 2018, with additional funding expected to come from concessional foreign borrowings, including loans from other development partners.
Increasing private investment in the sector – particularly raising the share of the population covered by private health insurance – could help the government achieve its aims and do more with public funds. PNG favours public-private partnerships and many nonstate services are delivered via churches with financial support from the private sector. However, private health care accounted for only 6% of total health care expenditure in 2015, and the health sector is currently one of the most underinsured in the world. Nonetheless, more people are coming under health coverage through their employer. Indeed, March 2019 saw the signing of a new scheme to cover all public service employees (see Insurance chapter). However, social health insurance is not a viable financing option due to PNG’s high rate of informal workers, at 67%.
Still, the World Bank suggests that it may not be funding that most urgently needs addressing, but rather the effectiveness of financial management. PNG spends more on public health than peers in similar conditions, yet sees slower progress in improving the nation’s health outcomes. This will require not only public financial management reforms, but also education at the facilities that receive the funds.
Disease
Communicable diseases are a widespread concern in PNG. TB is the fifth-most common cause of death in the country, although rates of the airborne disease fell between 2000 and 2015, from 18.7 per 100,000 of the population to 11.4. PNG’s national TB fund receives international assistance from organisations such as the Global Fund to Fight AIDS, TB and Malaria. However, Australian aid organisation World Vision notes that patients in rural communities may face difficulty in completing a full course of treatment due to poor access to medication, and patients may be inclined to stop taking medication once symptoms clear.
Moreover, PNG must improve its cold storage facilities to fight communicable diseases. The WHO administered vaccines during the 2018 polio outbreak, but limited cold chain management across the country restricted the number of hospitals that could house the vaccine. Communicable diseases can be greatly reduced by improving infrastructure and widening access so citizens benefit from earlier diagnosis and receive treatment more easily.
NCDs, meanwhile, accounted for an estimated 44% of all deaths in 2008, according to data published in 2015 by the Department of National Planning and Monitoring. The main culprit was cardiovascular disease, at 21%, with cancer accounting for 8% and respiratory diseases for 5%. In November 2016 the Parliament adopted the Tobacco Control Act to curb tobacco advertising and place health warnings on packaging. However, PNG has had trouble enforcing the act, as well as earlier legislation that banned smoking in certain public areas.
Solutions
PNG aims to establish a digital logistics system with the support of the Global Fund to Fight AIDS, TB and Malaria, and roll out a digital health system to collect and use data for decision-making. Such systems could help the country identify key causes of ill health and help deliver funds, medication and services to where they are needed most. While this technology will boost efficiency in the long run, it does require an injection of capital to take off. Thus, in light of the country’s fiscal constraints, the WHO suggests prioritising areas of public health where new tools would be directed first. For instance, the government could target maternal and child health alongside communicable diseases before shifting its focus to NCDs.
With regard to child health, crucial preventive practices include promoting quality nutrition throughout pregnancy and during the first 1000 days of a child’s life. UNICEF suggests that malnutrition is often not due to the unavailability of food, but rather the lack of awareness of the required nutrients that are key to helping children overcome illness. The UK aid organisation Save the Children states that nutrition programmes would be a cost-effective solution, although these currently receive little financing. Increasing preventive practices would not only improve the current state of public health in PNG, but also ease the burden on primary health care services to ensure their sustainability.
Looking ahead, improving PNG’s public health will require a combination of strategies and funding to expand access for both the prevention and treatment of disease. Greater education on practices to support maternal and child health, in particular, will help the country capitalise on its demographic dividend.
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