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Malaria data I agree with the author that filling out the current NHIS malaria data sheets, elevating and collating that information into a useful management tool for use at any level is fraught with issues. Elevating aid post records, sometimes months after the event to the NHIS begs the question as to what use it is at that stage. What are the issues that impact upon the quality of the data collected? Firstly, not all aid post workers have malaria data folios issued to them on which to record presentations. Secondly, there is a real question mark over accuracy of the diagnosis for those who do. If the standard issue rapid diagnostic kits are not available, the health worker may have to make a clinical assessment based on the symptoms of the patient. Assessments of clinical diagnosis versus gold the standard of microscopy reveals that workers who have to rely upon clinical diagnosis tend to record a positivity rate up to thirty percent higher than it actually is. Further clinical diagnosis is unable to delineate between a purely blood stage malaria or one with liver dormancy. The usual outcome is to assume the latter and record a mixed species infection which inflates that metric. When RDTs are used there is a tendency by workers pressed for time to shortcut the correct development time and misread the test strip. In reality very few of the 8,000 contributing sites have access to a functional microscope or a WHO accredited level a 1 or 2 microscopist. Less experienced lab techs have a tendency to miss P. vivax altogether or misread the ring stage as P. falciparum, resulting in data in either case being erroneously skewed towards the latter species. Under these circumstances RDTs have been shown to give more accurate results than inexperienced microscopists. There is a need to ensure that workers at every level are constantly supplied with RDTs and that community health workers in particular are provided with in service refresher courses to ensure they continue to read RDTs correctly. Then there is the issue of how best to utilise the data that is recorded. Let’s be clear, depending upon the local geography malaria incidence can vary markedly between communities along a 20 km stretch of coastline. Those close to creeks with still water lagoons may suffer incidence in the order of 100 (100 positive presentations per 1,000 in the population per annum) while communities located in drier locations might see incidence of less than 20 over the same period. Then there is the question of speciation. Does a community have the normal distribution of parasitic infections or is it skewed towards vivax or falciparum and which age group in family is presenting with symptoms? From the perspective of a local level government or district health manager this information is important and should inform the type of response, particularly in relation to community awareness and the vector control measures he or she recommends. The question then is do they get this information and if yes, do they act on it? In my experience visiting aid post workers in different locations throughout the country the answer is more likely to be once data sheets are collected, they never hear about them again. As for how the raw data is used at the level of the NHIS, I have yet to meet a district or LLG level worker who has received feedback courtesy of the NHIS. I agree with the notion of sentinel sites, but unless PNGIMR is properly funded it is doubtful their staff could monitor a sufficiently large sample to adequately to provide the level of national data coverage needed. If there is to be greater value obtained at the local level, I would suggest the focus be placed upon district level collection, analysis and appropriate action in accordance with the results.

A useful discussion on the collection, relevance and application of health data, which can also apply in principle to the routine or survey collection of other demographic, social & economic ( incl agricultural) data. Largely, PNG is highly deficient on routine and reliable data, although, as with basic population data, there are multiple partial, or partially completed, data collection vehicles rolled out by different institutions. Two principles need to be applied: firstly, restricting and agreeing to the relevant information required, both from routine collection, and specific surveys, and, second ensuring that the information, other than any patient- confidential material, is accessible openly and freely, to enable the national sector authorities, including Health and IMR, have access, but also wider institutions, researchers, and civil society organisations can also access it, both for analysis and accountability purposes. One shouldn't bring the bar to low, and assume deficient health sector institutions for ever, but provide what should be competent, if uncoordinated institutions to access priority and timely data, in parallel with seeking to restoring and upgrading that capacity. There are certainly many capable individuals working in the sector who both provide and demand sound information ... like the impressive team who've been working on TB out of the Kaugere sub- hospital, etc ... so making the data, and analysis of it, both widely available, but also in a relevant and accessible format are also crucial, and, as stated, this also applies in other sectors, where routine and extensive data is not being kept, nor has been for many years ...

Thank you for the comment and suggestion. It is a very interesting proposal. It seems to me there would be two associated challenges: increased counting time, and increased complexity for voters, who would have to fully rank candidates by preference (as I understand it). Both of these challenges seem like major impediments that would need to be planned for and overcome. Thank you again for your comment. Terence

Thank you for sharing your experience Hiroshi! That raises a lot of interesting topics: effects of Chinese' entry on local job market, agricultural cooperation results (the Chinese Government seems to be promoting more investment into agriculture), the migration scheme, and Chinese companies/migrants' localisation. Thank you and I am very interested in hearing more stories from you.

Would be interesting to know from the panel the need to review the current LPV voting to explore a full exhaustive LPV counting leaving the LAST MAN to stand or declared! This will allow all preferences from voters allowed to be counted not leaving behind a preference cast by voter.

Hi Sharon, thank you for your insightful posts. I do agree on you view that media in Australia, New Zealand and Japan and so forth have focused on downside of Chinese business. In this regard, I would like to share what I saw in Tonga when I worked there from 2019 to 2020. In Tonga, most of the retails (shops like convenience stores/small-size supermarket) are dominated by the Chinese. And those who sell vegetables at fresh foods market in the capital (Nuku'alofa) are mostly Chinese. Plus, there are a lot of Chinese people who works in construction sector. From negatively-biased view, we can say that the Chinese people steal job opportunity from the locals. But I did see many positive effects. For example, the Chinese business brings a wider range of daily necessities at lower price to Tonga, which supports everyday life of the Tongan people. In addition, thanks to the Chinese assistance to agriculture, we can enjoy various types of vegetables like eggplant, onion, and others. This might promote better health by eating well. Also, I found the Chinese people speak Tongan language very well, which is fantastic. What I heard from one of my Chinese neighbors is that they are recruited by the regional government and their temporary migration is planned scheme. So, there might be a special coordination at the government level. But I am not sure for this point. Chinese business in the Pacific has been very controversial topic, but the truth is little known ... I am looking forward to reading your next post!

Good article getting to the core of why we are so lost. The gap between strategy (what we think we should do) and operations (what we do) is very wide and has few bridges.

No. It was before 2016. Some minority groups in China were allowed to have two or three children (I think it was two for the Yi Minority group here) when others were allowed to have one child only. Despite so, it was very hard to implement the policies in small villages like this. In other places, people got fined or faced some consequences for breaking the rule. In this village, I don't see that happened.

Does the 7-8 average number of children in families stated in the fifth paragraph start after the Chinese one-child policy ended in 2016?

I wanted to share some research that I’ve completed on the Tongan context that could be useful for this. Young people in Tonga who were experiencing transnational parenting indicated they struggled to communicate transnationally with the parent who had migrated, particularly when parallel families had been formed. There were limited opportunities for visits to overcome this, and extended family were not accepted as substitutes for their transnational parent's absence. To navigate this, young people became increasingly self-reliant, altered their aspirations, and undertook extensive emotion-work to inhibit and conceal their emotional responses to transnational parenting.

Hello Mike, good to hear from you 🙂 You are right. Business is profit-driven. But in the Pacific context, competition does not bring more profits to business. Poor public perceptions and political interference leads to project failures and low returns. Even with policy incentives, Chinese companies still need be profitable to sustain their operations. So it is in their interests to live in peace with everyone and to improve local conditions. Interestingly many Chinese companies do think their operational purpose is related to local development because of their involvement in those "livelihood projects". It might sound insincere to say local development is their starting point, but at least it is aligned with the nature of business for now. I agree that it seems quite unlikely to talk and cooperate at the moment. Yet I want to highlight there are interests and needs for this from the private sector. One day our politicians might want to come back and think more about this option.

An insightful and well-written article conveying a perspective too often missed in the English language commentary, but I had to wonder about the concluding sentence. 'Since everyone’s starting point is to promote the long-term development of the Pacific'... Is promoting long-term development everyone's starting point? For private business surely the starting point would be making money. For outside governments, official rhetoric aside, their priority is clearly their own strategic position. Competition over profit or a position from which the sea-lanes can be controlled might align with long-term development, or not, but at any rate the reasons that business people and officials from China and the US led block are unlikely to sit down and sincerely talk about what's best for the Pacific any time soon are fairly clear.