Comments

Well done team. If this is the situation at district hospital level what would you conclude for health centres, aid posts and communities, many of whom are remote from a district hospital? A former deputy secretary for health and architect of the national TB protocol, commented to me that PNG is short of about 60,000 HCW of all types to provide an adequate service across all levels. But the National Department of Health and its provincial health authorities have insufficient funds to adequately support the skeleton staff levels or infrastructure they have now. Even if a Fairy Godmother were to kick in the hundreds of millions needed annually to rebuild the capacity of the health system, how could the government financially support this structure going forward? In my view there is a need to rethink what level of facilities government and provincial authorities should concentrate on coupled with an evolution in the way primary healthcare services are funded and delivered. In a country of nine, or anyone’s best guess how many millions of people, a geographically challenging environment with wholly inadequate infrastructure, there is an urgent need to explore local solutions to local problems. At present the communities that desperately need basic services are passive onlookers to whatever the government can provide. For many that means nothing at all. In my experience there is no reason why the people who want the services cannot become part of the solution. To do this they must be empowered economically and some of the output directed towards providing the outreach and "community-based" services they require. Women, who are the primary caregivers have a major part to play in this vision. While this may sound like pie in the sky, the economic component to underpin this has been successfully and sustainably demonstrated in remote settings throughout PNG. If primary healthcare indicators around TB, malaria, maternal and child health, immunisation and referral are to be improved the time has come to give end users agency over the outcomes they desire. This requires a broader vision with a multi-sectoral approach of which health service delivery is an outcome component. In partnership with district and local level government health authorities, make them part of the solution or risk being locked into a system that is unlikely to ever have the resources to solve the nations health challenges alone.

Thanks Jo, Just on the technical point, at some point I will re-run the regressions as ordered logistic regressions (separating effectiveness and efficiency), as part of robustness tests. But in our case I think we are already pretty safe taking averages. The scale is numeric (1 to 6) in AQCs/IMRs, which means the gap between ratings is likely to be perceived by those filling them out as more or less equal. Ordinal scales become more problematic when they are based on questions where the response scale is in words, and the gap less clearly equal, such as: how much do you like..."a little bit" "quite a lot" "a lot". Also worth noting is that we are averaging across two variables (not taking the mean of one variable) and using the resulting variable, which is much closer to being continuous. Thanks again Terence

Hi Maguli For further information on Australia's seasonal work and labour mobility schemes, please go to the Australian government website: https://www.palmscheme.gov.au/

I'm interested

Faafetai Richard - it was Oikoumene’s brilliant analysis and presentation at the 2022 DevNet conference that has prompted my question. What was striking from her research was the overwhelming imbalance in the gains from official revenue streams for NZ ie: income tax, employer registration fees, etc, compared to Samoa (the one Pacific country her research focused on). I wonder if the same research scope and analysis was applied to other Pacific sending countries whether it tells a similar tale of two systems.

What are the bilums made of?

Be great to read an article on this graduate research project Mr Bedford and Charlotte?

Congratulations on your persistence despite the many challenges. Jeremiah 29:11

Malo le soifua Toleafoa, thank you for this comment on the debate about numbers of seasonal workers. I agree with your concern that a more relevant focus for debate is the balance of economic and social costs and returns for New Zealand compared to the Pacific countries in the RSE scheme. This is a matter that was raised in our study of the impact of the RSE scheme in New Zealand and Australia in 2019 (reports available on the Ministry of Business, Innovation and Employment's website (https://www.immigration.govt.nz/about-us/research-and-statistics/research-reports/recognised-seasonal-employer-rse-scheme). One thing we did not explore in that study was the comparative financial costs and returns to the New Zealand Government and the Samoan Government. An interesting graduate research project on this topic has recently been by Oikoumene Maualaivao-Chan Tung entitled: "Who is developing who? An analysis of the financial contribution of the RSE Scheme to the New Zealand and Samoan governments through a Fa'afaletui Pacific lens" (Massey University, Palmerston North).

God bless the merciful

I wonder if the continued debate on what are the right numbers of RSE workers, suitable for NZ, is diverting the focus on another set of potentially important numbers, the balance of revenue and economic returns for NZ compared to the Pacific countries in the RSE Scheme.

What an amazing personal story and it goes to show that if anyone or anybody really have a dream to become what they want to be, it come to sheer determination and the results are great accomplishment 👍🙏😀