Rural Health Service Delivery in Papua New Guinea is More Than Capacity Building.

The National newspaper 25th of July 2012.

Trained Health Staff Needed.

TRAINING and increasing the number of health workers in rural areas is the way forward to bringing health services closer to the people, an expert says. Australian Doctors international (ADI) marketing and communications manager Leah Boonthanom said volunteer doctors who carried out patrols in the remote areas were mainly focused on promoting clinical care. She said training of local community health workers would ensure that health services were carried on after the volunteers left.“The best approach to health care in PNG would be working as part of an integrated team that incorporates capacity building as a major goal,” she said. This meant strengthening skills, competencies and abilities of people and communities so they could overcome the causes of their exclusion and suffering.ADI has been in PNG since 2000, previously in Western province and later in New Ireland.“We consider our work in New Ireland a success because of the great support we received from the provincial government, Namatanai LLG and Newcrest Mining,” Boonthanom said. She said with more support, they were able to take a bigger team, including specialists such as an eye nurse, TB expert and Pap smear nurse, into the remote region. She said many of the locals in the outer islands of New Ireland were unable to seek medical help because of high transportation costs.“If the services don’t go to them, than it’s difficult for them to access these services,” she said.“Some of them even say health service is the only service reaching them through ADI.” ADI currently has two volunteer doctors in the province – Dr Romany Topsfield at Namatanai district hospital, and Dr Rosemary Lee, who would be carrying out monthly patrols with a team of specialists, into rural New Ireland.


I used to hold onto the strong view that capacity building of rural health workers in PNG is the way to deliver rural health services. However, after spending 2 years working at the Immanuel Lutheran Rural Hospital in the Enga Province, and conducting numerous rural health centre visits and clinics, I came to the conclusion that capacity building is only a part of the solution. Not THE way.

My experience is that attracting health workers to a rural post with incentives either be financial or training will attract many but keeping them there for long periods of time to make a real impact takes more. Major issues that need to be addressed are (according to my analysis):

  • Road infrastructure – can not over emphasis this. This has to be improved. Roads need to be sealed with regular maintenance. I drove through very rough terrains to go to conduct health centre clinics.
  • Communication infrastructure – this is vital not just for hospital administration but for the health workers to communicate with peers, specialists, friends, relatives etc. Mobile phone is good but I had problems when trying to send or received faxes, or email a colleague to get an opinion on a patient or a chest x-ray. It also allows health workers to get continuing medical education either by correspondence or online.
  • Banking services – health workers must be able to access banking services at the district level. Otherwise they will travel to major centres to access cash from an ATM or send money for relatives. This will mean the health worker will be absent from work.
  • Better education services – health workers in rural health centres want a better education for their children. My experience has been that when their children are old enough to attend school, health workers will leave a rural post and move to a major centre so that their children can get a good education. The perception among health workers now is that rural schools offer a poor quality education because the infrastructure and the curriculum is not supported and better resourced by the government to improve its quality.
  • Good accommodation – this is addressed in some areas now. But this  needs be sustained.

I think when these areas above a addressed as a priority and at the same time build the capacity of the rural health workers, PNG will begin to see real change in the health status of our people. Delivery of health service to rural PNG is a developmental issue therefore needs to addressed as a whole part of development. A piecemeal approach is not the way to go.


About rodney itaki

Medical doctor and public health specialist from Papua New Guinea.
This entry was posted in Health and tagged , , , , . Bookmark the permalink.

3 Responses to Rural Health Service Delivery in Papua New Guinea is More Than Capacity Building.

  1. Magdalene says:

    I’m really very interested in assisting especially in the rural areas, but have no idea, maybe go to some sort of training and then would assist in the rural areas, especially in my village health is very poor.

    • rodney itaki says:

      We can do the basic things like proper sanitation and good drinking water for our people and build from there. Let me know what kind of training you require.

  2. Kelvin R Natata says:


    When the Pope or Queen of England visited PNG last, full State protocol was observed and red carpet laid out for them, with all the ladies and gentry of the former Territories turned up in their finest regalia, and happy flag waving school children lined the streets, shouting and singing various welcome songs composed in their honour. The faithful flew in from every part of the country to pay homage, went away fulfilled and satisfied.

    One such visit in the early 1970s was by then Australian Prime Minister, Hon. John Gorton MP and his wife Lady Gorton. There was a guard of honour led by a very sharp young military officer trained in Australia named, Edward Diro, who was eager to impress. The renowned award winning Police Band from the Bomana Police College took their place and played few Frank Sinatra numbers for the tense crowd gathered at the old terminal in Port Moresby. The usual who’s who among the 100,000 strong expatriate community sat on white chairs looking their Sunday best.

    Around the low wire barrier or fence with steel railing were Policemen with police dogs acting as perimeter guards against the throng of anticipation building up and pressing, as the approaching official DC3 aircraft rumbled to a stop.

    As soon as the engines whined down, the doors opened, and a white gloved Mrs Gorton with neatly coiffured hair and a pin stripped Mr Gorton, alighted from the aircraft to the tarmac, to meet the awaiting dignitaries and inspect the guard of honour.

    However, as soon as Lady Gorton’s feet touched the tarmac, someone in the crowd released a white greasy pig onto the tarmac. The frightened little pig ran straight between the soldiers, directly for Lady Gorton, who shocked and horrified upon seeing the squealing pig charging at her, suddenly fainted on the tarmac.

    As Prime Minister Gorton and other dignitaries tried in vain to resuscitate Lady Gorton on a hot sweltering day, the frightened pig turned for the seated gentry. Many ladies fainted in their finery; some simply scaled the low fence, dress and all, while the pig dashed about and straight for seated the Police Band playing, knocking over music stands and causing the band to erupt in hitherto unknown and unheard tunes of disarray.

    Meanwhile, the police dogs observing this harmless little pig decided this was fun, or the pig would make good lunch, either way, their hunting skills took over and even they decided to join in and give chase. There were Police Dog handlers being dragged all over the tarmac, while Edward Diro struggled to keep his white gloved parade lines straight in the midst of this ruckus.

    Several highlanders decided to join in to rid the occasion of this errant but juicy little pig, and you can imagine the rest!

    Of course, we know now it was Gorton who took the (initial) unilateral decision, immediately upon return to Australia, to prepare the Territories of Papua and New Guinea for immediate political self-government and independence.

    The reception a banner saying “WELCOME : JOHN GORTON, PRIME MONSTER OF AUSTRALIA” followed by a demand for self-determination and Independence, coupled with a pig tackling lady Gorton at the tarmac that fateful day in Port Moresby, affected Gorton deeply. So deep was the affectation that the decision to trigger self-determination and be done with the savages was taken most unilaterally by Gorton without consulting the TP&NG Administration as it was customary to do in such matters.

    Julie Bishop on the other hand has been fortunate to be well received in PNG without such ruckus or hilarity.

    In Lae she stood out in her creamy white suit top and her dark slacks, well complemented by Governor Naru in his white top and dark slacks (minus buai), while the MP for Lae looks like a gypsy emerging from a second-hand outlet, swaying like the hanging gardens of Butibum, clad in assorted buai red of Sipaia by the sea.

    Bishop made 2 significant statements while in PNG.

    Firstly, she said Australia will counter-fund AUD$250 million for rebuilding of ANGAU Hospital (named after the Australia New Guinea Administrative Unit that took the two territories under one Administration under certain mandates from the UN) in 1952. However, Bishop did not outline where her funds will come from and how it will be given to PNG.

    In recent times, we have seen so many empty promises made by Canberra to PNG.

    In the case of the Manus Refugee Processing Centre, Australia promised PNG would benefit, and the people of Manus would benefit to the tune of tens of millions of dollars. That has been a lie told by then Australian Prime Minister. Recent Newspaper adverts taken out by Australia with glossy figures of benefits to PNG from the Asylum deal are all a calculated sham. The main contractors earning 90% of the contracts are all Australian and British companies on Manus, and off Manus. The MP for Manus who earlier welcomed the Asylum deal on the back of such promises stands betrayed by Australian and PNG Governments. The people of PNG have been lied to.

    At a time with a very high budget deficit and the Abbott government struggling to meet its own balance of payments, Julie Bishop has not told us where this extra $250 Million is going to come from. We can only assume it is from budgeted aid funds. It is also not clear whether the $250 Million is part of the normal $300 Million aid to PNG or not.

    The Abbott government upon election abolished Ausaid, and parked all aid funds with Julie Bishop’s Department of Foreign Affairs. That way, she can carry Australia’s aid cheque book around and play Father Christmas/ Salvation Army and Mother Theresa, all rolled in one, all over the Pacific.

    What is also little known is that there are funds from the UN that Australia accesses to channel as aid to the Pacific. For many years Australia has been using these funds as tied aid to achieve its own strategic ends in the Pacific through Ausaid, even though they are our regional entitlement by the UN.

    The PNG and Pacific’s experience of Ausaid has been a bitter-sour one. Australia uses its aid as a control tool of the Pacific countries. It sends in its Briefcase/Suitcase Brigade, commonly known as “consultants” and sucks back every dollar it gives, while in the meantime, it rewires all the politics and economies of the pacific to its advantage. A certain Pacific statesman has in the past branded this phenomenon as “Boomerang Aid”. Today, along with consultants, it sends Australian companies to implement aid projects.

    From our past experience, every PNGian can bet their brown arses that no PNG individual or company will see the $AUD250 million that Bishop so generously announced for Angau. It will be spent in Canberra by Australians on Australians, but in our name.

    In the meantime, Julie Bishop has successfully put a bomb through the credibility and reputations of our own national Ministers for Health (Michael Malabag) and Planning (Charles Abel) who have already planned and agreed on a way forward for Angau. With their plans, reputations and credibility in tatters, let alone the national Health Plan, where will they find the extra K600 million to pump into Angau, when they are struggling to fund Port Moresby and other General Hospitals? Port Moresby Hospital’s budget has already been cut in half, where is Julie’s announcement going to leave the patients of Port Moresby if scarce funds get redeployed?

    Bishop’s Second Statement on the issue of reciprocal visa on arrival treatment of PNGians is most sinister indeed.

    When Prime Minister ONeill has pushed for Visa on arrival in Australia, seeking long outstanding reciprocation from Australia of PNGians visiting Australia, Bishop said, if PNG wants visa on arrival in Australia, then Australia demands the following:

    1. Close co-operation on border security management systems,
    2. Integrate foreign affairs and Immigration systems,
    3. Integrate the Judicial systems,
    4. Integrate the behind the border systems.
    5. In the meantime PNGians have been offered online visa application using their own computers or laptops.

    These are unreasonable demands that we do not make of Australia when granting them visa on arrival. The writing has been on the wall for PNG citizens and Mr ONeill for a long time on this issue. We have failed to see it.

    Australia has a phobia about Melanesian people. It is a phobia that Australia obviously does not have with Polynesians, who gain easy visa access to Australia. Every town and city of Australia now has many Cook Islands, Samoan, Rotuma and Tongan Communities, replete with churches football clubs and other ethnic endeavours.

    However, there is not even one PNG community with its own church and clubs etc. The Polynesians with less than 300,000 people have done it, while PNG with over 7 million people, a former colony of Australia, has been kept out of Australia by deliberate government policy for over 40 years.

    Unlike Australia, New Zealand allows its former colonies and protectorates easy access to New Zealand and its universities and colleges. As a result Polynesians have advanced relatively fast. England, France, Spain, Belgium, Netherlands etc have various relaxed rules about their former colonies.

    Speaking of giving up our sovereignty under the guise of border control programs, Singapore does not ask PNG to integrate or put its government apparatus under the control and interference of the Singaporean government in order to grant us visa on arrival, yet 5 plane loads of PNGians land there every week.

    Malaysia does not ask PNG to integrate PNG’s sovereignty with Malaysia to grant us visa on arrival.

    Indonesia does not ask PNG to integrate our sovereignty when its own when it grants us visa on arrival in Bali. We share a common land and sea border, but it does not seek to hijack our sovereignty with draconian border control policies.

    The Republic of Philippines does not ask PNG to integrate PNG’s sovereignty with its own yet 5 Air Niugini flights land there every week.

    Fiji, Solomon Islands, and Vanuatu, all black Melanesian countries, where PNGians could easily run away and melt into their communities, do not ask for us to integrate our country’s sovereignty with theirs nor have we asked same of them.

    All European Union countries under the Shengen Visa arrangements, including Great Britain, have not asked us to integrate our sovereignty with them.

    Sovereignty and Visa on arrival are two separate matters. They are mutually exclusive issues. They are not dependant on each other. Who is Australia trying to fool?

    A countries border issues are absolutely irrelevant to matters of international comity, polity and reciprocation. They have always been and will always be. Nation States have in the past both recognized and granted visa reciprocation. Where there is no reciprocation, the granting country has the right to refuse or withdraw the privilege. Most certainly visa on arrival is a privilege, not a right. In PNG’s case, Australia has deemed us undeserving of that privilege.

    What Julie Bishop has just made public is a plot most sinister. As crazy as it may sound, it is part of a naked and shameless plot to hi-jack the sovereignty of PNG.

    If Peter ONeill and Rinbink Patu cannot see through this obvious subversion of proper rules of international comity by Australia to serve its own regional strategic game of domination, they display lack of intelligence and low self-esteem that renders them unfit to be leaders of PNG. They might as well go and join their children in Australia and live down there!

    What John Gorton said, what subsequent Australian Prime Ministers Whitlam and Fraser maintained upon granting of Self Government and Independence, was that PNG was a difficult country to manage: grant them political Independence, and when they fuck it up, we can justifiably march in and take control without firing a single shot. That way they (PNG Leaders) would shoulder political responsibility to manage a tough country, but we (Australia) can happily harvest the benefits economically and exploit their resources without much upfront investment and associated risk. A brilliant strategy!

    In this sinister plot, Peter ONeill and Rinbink Patu are actively complicit. They have sold out PNG.

    Upon refusal by Australia to grant reciprocity 3 months ago, O’Neill should have denied them visa on arrival immediately. There is a NEC decision to this effect. But as Chairman of NEC he has deliberately not signed it, and therefore it has not been implemented. Why didn’t he sign it? Only he knows.

    The fact that he has waited, and worked with Australia for this announcement by Julie Bishop, and taking into account other decisions O’Neill has unilaterally made on the asylum deal and the ECP Program, it is clear Peter O’Neill is most complicit in the plot to sell out PNG’s sovereignty.

    The entire hype and recent radio talk back program on this visa issue by ONeill is just public grandstanding and a smokescreen, just like:

    1. Bougainville, where he has gone to pave the way for Australia to re-take the mine,

    2. all the hype and talk to immediately sell the PM’s Falcon Jet which he hasn’t and instead flying around the world in it himself,

    3. the Lae–Nadzab road contract price inflation investigation which he has done nothing because he knows who inflated the contract price,

    4. the continuous crying foul in the media over corruption and theft of public funds when he is aware who is doing it;

    he is good at saying one thing and doing another.

    It is now questionable who Mr O’Neill really works for, and what sort of leader and Prime Minister he really is. He can fool us once, but he can’t fool all of us all the time.

    As for Julie Bishop, she is as two faced as they come, and it is clear her intentions concerning PNG are not honourable, nor are they in PNG’s best sovereign interests. She is not a friend of PNG. She is not a blessing.

    If Australia didn’t have this “brilliant strategy”, it would have granted free visa access to PNG citizens just as New Zealand did to its Polynesian protectorates, and we would be far advanced by now. We would have healthy education and health statistics, more economically developed with strong infrastructure because of advanced manpower, educated and skilled population, strong middle class and active citizen business community just like Malaysia is now. We would have managed our natural resources for better returns, and would already have already emerged as a major power in the region in our own right.

    In 1970 we were on par with Malaysia, but Australia has deliberately down played PNG and its potential in the region to create and maintain this aid bound dependency syndrome- a curse! Today, we are more than 50 years behind Malaysia, and regressing with the rest of the Pacific into aid dependant enclaves of Australia.

    At last an Australian leader lets the cat out of the bag, so to speak, the truth of Australian designs on PNG all along, the “brilliant strategy”, since Gorton, Whitlam and Fraser is now out!

    Let it be known that there are many decent Australians, people who have worked tirelessly in PNG for its welfare and advancement, people who believe in this country and its people and its future are perplexed with their own government’s policies. Canberra makes them cringe in shame. They find what is coming out of Canberra in terms of foreign policy posture most troubling because of its hostile overtures.

    Canberra seems to operate independent of Australian public opinion or opinions of Australians deeply connected to PNG. Those Australians who know PNG better than the desk jockeys of Canberra constantly find themselves in this uncomfortable place, to defend Canberra’s position and policies that they don’t believe in.

    The Australian people should rise up and tell their government to stop this madness. Leave us in PNG and other Pacific nations alone. Allow us to develop as equal partners with mutual respect and co-exist peacefully in the region. Cease using aid overtures to steal our sovereignty, our resources and our children’s heritage and opportunities.

    It is a shameful, subversive and underhanded plot Julie Bishop has revealed. The Post Courier as Australian agent provocateur has editorially embellished and conditioned it as normal and proper. A shameful and subversive thing to do.

    As descendants of first boat people who arrived in our waters recently, only 200 years ago, and as guests on indigenous soil, Canberra must show restraint and respect, and not take advantage of the carnal weaknesses of our political leaders like Peter ONeill or Patu. Our leaders like ONeill and Patu have their kids and family ties in Australia, but their personal interests should not be used and exploited by Australia to subvert the national interests of PNG and its people.

    We the people of PNG have eyes and can see what Canberra is really doing no matter how sugar coated the prose may be. Julie Bishop and Canberra, you must stop this madness immediately.

    Australia should instead tell us when it will cease occupation of Solomon Islands, now that the peace keeping role has been long over some 10 years ago! There is absolutely no need for Australian continuous occupation of Solomon Islands.


Comments are closed.