Sunday, May 8, 2016

A simple analogy of health service user fees in PNG

Wanpla papa em name blong em ‘John’ na em I gat wanpla kanu. Displa papa i promisim ol pikinini blong em olsem em bai lukautim ol na displa kanu bai givim helpim lo ol taim ol i bungim hevi. Nau displa kanu i gat wanpla wokboi isave lukautim em na papa blo kanu i save baim wokboi sampla moni lo wok em i wokim. Planti taim wokboi em i save hamamas tru lo wok tasol sampla taim, papa blong displa kanu ino save givim mani blong stretim kanu or baim nupla pul or stretim saman blo kanu. Nau, kanu ino stap stret na halivim igo lo ol pikinini blo John ino kam gut tumas. Ol pikinini blo John bungim hevi na wokboi I wari lo ol. Wokboi i kirap na tok: ‘Ol pikinini, sapos yupla laik mi halivim yupla, orait yupla putim mani kam na yumi stretim saman blo kanu na displa kanu bai halivim yumi gen’. Ol pikinini i harim displa na tromoi mani igo lo wokboi na wokboi usim mani lo stretim kanu na i halivim ol pikinini. Papa blo displa kanu I lukim displa samting i kamap na korosim tru wokboi na tokim em lo stoppim displa pasin. Em tokim wokboi: ‘displa em kanu blo mi na mi bai givim mani or stretim lo laik na taim blo mi, ino wok blo yu lo painim mani na stretim kanu’. Wokboi i harim displa na em i belhat nogut tru na tok: ‘Boss, yu stap na lukim hevi kamap lo kanu na yu no stretim, yu larim ol pikinini blo yu bungim bikpla hevi tumas. Mi stap wantaim ol na mi lukim hevi blo ol. Nau yu tok mi noken kisim mani halivim lo ol pikinini lo stretim displa kanu. Displa kanu ino halivim ol pikinini blo yu blong wanem yu yet ino stretim displa kanu.  Na yet yu tok mi mas ronnim displa kanu na stap isi tasol. Boss,displa toktok blo yu em i asua tumas'.

In this story, the 'papa blo kanu' is the Government, the 'wokboi' represents public health services and the 'pikinini' represent users of the public health system. This story above is a simplified version of public health services such as hospitals, district hospitals, health centres charging the public, user fees, to operate and maintain their respective services while the government looks on and does not fund the required infrastructure and maintenance of primary health care. 

Now we hear that the government has cut K50 million from Church Health Services this year. Where is the rationale in this? All the Community Health Worker Training Schools are run by Churches. 

In 2012, the PNG Promoting Effective Public Expenditure(PEPE) project surveyed 360 primary schools and health clinics across eight provinces. Many of the same facilities were also surveyed in 2002. They discovered that the average health clinic sees fewer patients and has a lower level of drug availability than ten years ago.
 • 41 per cent of clinics received no external funding or in-kind support in 2012.
• 29 per cent relied only on user fees to cover operational costs.
 • Only 20 per cent of health clinics have beds with mattresses.
• 75 per cent of health workers contribute to the cost of health care delivery from their own pocket.

The PNG health care system is really on life support.....

But there are good strategies for the way forward such as the private partnership programs between the state and private institutions to bring health services such as Oil Search in delivering Malaria and HIV/AIDS  programs. A key point highlighted by Feachem et al is changing the way we have been doing things in order to achieve better health outcomes. In their report, they pointed out that the PNG Government must implement a newer approach to managing health which is to embrace public private intergrated partnership (PPIP) whereby the government become 'stewards' rather than 'providers' of the health system.