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From Dr Paison Dakulala on PNG’s health data: too much of a good thing – part one
Dear Dr. Hetzel,
As the Secretary for the National Department of Health of Papua New Guinea, I wish to respond to the two opinion pieces published by Dr Manuel Hetzel of the Institute of Medical Research in the Devpolicy Blog.
The criticisms of the National Department of Health’s (NDoH) National Health Information System are factually incorrect, and are not supportive of our progress with health system transformation through improved performance monitoring. Such criticisms and lack of meaningful engagement erode the strides we are making in improving the timeliness, accuracy, usefulness and impact of the nation’s health data systems. We share an expectation that foreign consultants do not undermine our national efforts to develop and build world-class data systems.
Dr Hetzel states that “most importantly, a health information system must be owned locally and designed in a way that is consistent with the country's capacity to operate it and utilise the data for improved programmatic decision-making.” The electronic National Health Information System (eNHIS) is nationally owned by the NDoH and replaces a moribund system running on non-supported software that we have had in the country for decades.
Given Dr Hetzel and colleagues at the Institute of Medical Research have access to the NDoH’s more than 1 million suspected malaria patient testing records, geo-located to one of more than 20,000 villages and urban settlements, I would encourage Dr Hetzel and colleagues to reflect on their role as malaria researchers and to use these data to better support the country with more meaningful contributions.
Dr Hetzel’s statement that health workers need to collate “an increasing amount of data at the end of each month from tally sheets and the recently introduced ‘Malaria Register’” is factually incorrect, entirely misses the point of our data transformation over the past 5 years and highlights his lack of understanding of and engagement with our national health data systems.
To be very clear, the NDoH’s eNHIS malaria testing register contains 13 clinical and demographic fields that are then used to automatically generate the indicators required to monitor malaria and manage the program – collation does not fall on the health worker and they are certainly not required to complete both. Innumerable malaria indicators can be automatically generated from the existing data capture, so the commentary around WHO and Global Fund requirements for malaria indicators creating a burden is simply not true. Fortunately, we have overcome the previous challenge of ensuring that Global Fund supported malaria partners cease to send our national malaria data offshore for entry into systems outside our national health information system, which effectively paralysed the capacity for national malaria monitoring.
Dr Hetzel claims, “ls all this additional information needed, and is it used? The short answer to both questions is no.”
The department does not subscribe to Dr Hetzel’s logic that if programs are weak, what is the use of data? “...[D]espite half a page of the ‘Monthly Report’ being dedicated to medicine shortages, the collection of the data did not prevent (or lead to rapid mitigation of) large-scale antimalarial drug stock-outs observed in previous years.” I believe that any weaknesses in medical supplies systems does not mean that medical supplies data are not important – to the contrary, it is with better data that well managed programs can make greater impact. The important steps taken by the proactive use of technology to enable the government to make data-evidenced solutions is our national objective.
A recent National Malaria Program Review for the development of the new National Malaria Strategic Plan, concluded that eNHIS contains all the information a province or district needs to run a successful malaria program. Dr Hetzel was part of this team. While we acknowledge the system is not being used to its potential, we are actively engaging with the provinces to make better use of their data for monitoring, evaluations, and reactive planning. The innovative approach of mobile tablet data entry we are implementing enables automated feedback on performance for all reporting health facilities every single month – never previously achieved and not achievable in the Papua New Guinea context without electronic data systems at facility level. Further, the eNHIS has been enabling data quality checks upon data entry to improve data quality at the periphery. As part of the nation-wide rollout, the tablets have been deployed to 1/3 of health facilities in the country. Unfortunately, COVID-19 has disrupted the expansion which will continue in the near future to the remainder of the provinces to be completed in 2021.
We expect the modernised NHIS to use the existing geo-coded national household and village datasets to better utilise the NDoH’s capacity for planning, monitoring and evaluating bed net distribution campaigns, monitor spray programs, and track individual case follow ups.
I would encourage Dr Hetzel and colleagues to have greater engagement with the health data landscape in Papua New Guinea and all of its stakeholders and to identify how a greater contribution can be made than undue critiques that do not portray the efforts made by the NDoH in the last 5 years to modernise the NHIS.
As a nation, we require credible agencies to assist us with using our NHIS to tell us, for example:
* How can data on treatment administered be used to monitor and enable the most rational use of anti-malarial drugs?
* How can data on malaria-negative patients from the malaria testing register be optimised for detection of outbreaks of (non-malaria) febrile illness and actually be monitored by local authorities?
There are many more public health issues we can solve with data.
With health data systems that can now tell us what facilities are open, about the nature of their service delivery and who from public health programs is logging in and using the data (including your malaria program counterparts), we have the nationally owned tools that we as the national health authority consider appropriate for our context. This is further evidenced by the assistance of both Australia’s Department of Foreign Affairs and Trade and the Asian Development Bank that have been supportive of our efforts over many years.
We look forward to a more meaningful dialogue going forward.
Yours Sincerely,
DR. PAISON DAKULALA
Acting Secretary
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From Grant Walton on Boom and bust? Political will and anti-corruption in Papua New Guinea
Hi Paul,
As I've noted a ‘boom’ is not just a product of the percentage of the spending allocated to all anticorruption organisations. We do not narrowly define it as such, as I've mentioned. Apologies if this is how it comes across in the blog. The boom includes setting up of taskforce, allocations, funding to key anticorruption organisations. etc. The graph above is only a part of the story - which shows the significant rise of allocations.
A key question about capacity is whether the O'Neill government inherited a set of organisations with the capacity to spend their allocations. This is an open question, which the O’Neill government would probably say no, while others will disagree. Arguably, any government has a better chance of shaping that capacity and the ability to absorb funding allocations over time. Still, this is an interesting line of enquiry that deserves more research. In our paper we give the O’Neill government (as we would the Marape government) the benefit of the doubt while noting the problems associated with underspending. I suggest you read the full paper.
Best,
Grant
From Paul Flanagan on Boom and bust? Political will and anti-corruption in Papua New Guinea
Hi Grant
Thanks for the response.
On the evidence of actual practice - the criteria of backing up with 'cold hard Kina' you mention - there was no boom. The anti-corruption expenditure share of the budget fell in the first three years of the O'Neill government. By 2017, it had been cut by over a third.
'A lack of capacity' to deliver on 'political will' is not an issue here - higher shares were actually expended in both 2009 and 2011. So the O'Neill government early years appear to be very big on promises while actually cutting expenditure despite the capacity being present. Is this a boom? Not when tracing the 'cold hard Kina' trail. And is it a basis for saying the new Marape government is demonstrating less of a commitment? Maybe the 10% increase (from 0.3 to 0.33%) is just more realistic?
Another interesting comparison will be the current UBS Inquiry and how it goes relative to the abandoned UBS Leadership Tribunal inquiry (and subsequent moves in senior personnel).
With respect
Paul
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