Comments

Well written piece. There are two more factors based on personality and tribal politics that will ensure Marape remains for the full term. Maybe the research team can do further research. Firstly, I call it the 'support of the big 4', these 4 MPs will cause instability if they move to the opposition anytime between now and 2024. The big 4 from my perspective are; Kramer, Bird, Maru and Juffa. They are outspoken and influential party leaders. Secondly, I call it the 'Hela-Opene political alliance', MPs from Hela and Enga are brothers according to traditional folklore. Engan MPs like Lino who recently became leader of the People's Party will remain loyal to a Marape because he is from Hela.

You are most welcome and take care.j

Thank you for your comment John.

Well stated, i agree on your statement as a citizen of Papua new guinea.

1. How much is paid per fortnight? 2. How much will be declared for food? 3. How much will be declared for room rent? Please answer all my question above.

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.