According the World Health Organization (WHO) the 6 building blocks of any health systems are:
1. Service delivery
2. Health workforce (HR)
4. Medical products, technologies and vaccines
6. Leadership and governance
I have noted that a major challenge to UHC and PHC in PNG is poor leadership and governance. That needs to be strengthened. Health financing is an ongoing issue. I have read in yesterday’s news papers that the Church Health Services are shutting down because the government has not paid the salaries of the church health workers. This is unfortunate but this is the sort of thing that needs be improved. I think there should be some kind of financial protection for health services – especially for the rural and remote population. And the church health service is a major actor in this space. Another thing that I have noted is that too much emphasis and funding has been directed at clinical services in PNG. For example UPNG has a very strong program in post graduate training in the clinical specialties (surgery, pediatrics etc) but the public health training is very weak and not well supported. Even overseas partners have focused on clinical training and little resource allocated into public health training. So I think the proportion of healthcare workforce that is well trained in public health is very small in PNG. This number need to increase so that they can become key drivers and advocates for reforms and improvements in public health, especially in advocating for health equity for the rural and remote population.
Another thing I see in PNG that need to change is that too much resource and financing has been put into building super high technology hospitals. We need these too but if we are to improve health equity, promote UHC and PHC, it is obvious that resources are allocated to the wrong place. We can have a well built hospital with all the good technologies but it will be accessible only the rich and those who live in the urban areas. The poor and those living in remote areas will still not have access to these sophisticated services despite the fact that it is available. In other words available but not accessible! So there is no health equity here – the person who needs it most will not use the service. Another good example I can share is the cancer treatment facility being built in Port Moresby (within the Port Moresby General Hospital). Interest groups and other advocates have persuaded the government to make this massive investment in cancer treatment. But where is the investment in cancer control and prevention? There is no population level intervention, it’s all clinical. There has been no government initiative to control cigarette smoking or betel nut chewing – 2 major risk factors (modifiable) for the common cancers in PNG. We have laws and cancer control policies but these have been poorly and haphazardly implemented. How will a mother in a rural village in PNG diagnosed with cervical cancer have access to the cancer treatment facility based in Port Moresby? There is no equity. In fact the intervention will further widen the health inequity in terms of cancer care! This danger has been experienced by other countries so we need to learn from other countries. I think having more people trained in public health can be a way to influence and advocate for population level interventions to improve health equity, implement UHC and PHC rather than clinical care interventions.
I see that implementing UHC and PHC in PNG is a development issue, not necessarily a health issue. I see that PNG government appears to focus on economic concerns and focusing on economic policies and trying to create more jobs, things all politicians seem to talk about, but they appear to forget that health is an economic issue! With poor health increased economic productivity is not possible or that with poor economic performance of a country, implementing health initiatives is not possible. It’s a bit like saying which comes first – the egg or the chicken? Investing in health is investing in economic growth. And in the context of UHC and PHC, government needs to spend more in rural health services and population level interventions.
The vision of UHC must be captured in ALL policies that we have in PNG. We should have healthy policies or health must be captured in ALL policies. This is in line with the WHO Health in All policies initiative (HiAP). Every policy that we have must be reviewed by public health experts to ensure the principles of UHC and health equity are captured in these policies. So that any development projects that we have must ensure it enables access and equity in health for all. For example, if a new supermarket is constructed, we must ensure the new facility considers the disabled and senior citizens. Or that road projects must be initiated to ensure remote and rural communities have access to other economic benefits that directly or indirectly benefit their health. Education is another major concern. Education initiatives must not only focus in towns and urban areas but it must be government policies to ensure education opportunities are available to the rural and remote communities. These things cannot be done overnight but we must have that long term vision and goal. Unfortunately what we see in PNG is that with each new election and new government, the development direction and focus shifts and changes and we do not see good initiatives being sustained over 10 to 20 years to see real benefit.
Leadership and governance is another major concern for us. Being good stewards of the resources (financial and non-financial) we have been given to manage and manage them well to ensure healthcare equity is achieved. Leadership and governance is something we need to strengthen at all levels of government – health and non-health sector. I also believe that good leadership and governance and good stewardship is strengthened if we have strong moral and ethical values. What we see in ourselves as good and just and that we as leaders are the people’s servant – servant leadership style so to speak. I think these things have a lot of influence, shape and strengthen leadership and governance. I think over many years PNG’s traditional values, moral standards and ethical values have eroded that people in leadership roles take the opportunity to better themselves and not the society in which they live. Some of this deterioration is seen in the poor leadership, governance and stewardship that we observe in our systems (health and non-health). There are other issues like law and orders situation, geographical challenges and the like but for me the above points are important for implementing UHC and PHC in PNG.
Please share your thoughts.