Comments

Yes indeed - having undertaken research in Lihir for a decade (1995-2005) and seeing various other facilities in areas affected by mining, the variations are deplorable. But ultimately the PNG government is responsible for the health of the population and income from resource extractive projects seems to vanish into thin air. When some places have adequate, or even excellent, health care provision and others have none at all the government should be held to account.

Thanks for your response. I agree entirely.

Taiye, I am well aware that often the facts are hard to acknowledge, especially when they are made by an 'outsider'. Over the years I have spent a lot of time talking with people who work in the PNG health system. I have enormous admiration for their dedication and capacity to carry on treating people in extremely difficult circumstances. But as you can read in the longer version, my criticisms are also directed at the sort of aid programs from Australia that concentrate on systems but cannot be implemented because the basic things are not there - good facilities, reliable pharmaceuticals and equipment, well-paid staff, emergency medical service provision. I was constantly amazed at how low wages are for highly trained nurses - maybe I should write another blog!

I shall read it with interest. Your thesis is indubitably one of the best studies of the health situation for women in PNG that I have read in years. Is it to be published? I hope so. But alas, good analyses can only identify ways of dealing with the problems. The political will to solve it is what is needed now.

I write as a woman, a mother, an aunt, a sister and a cousin to many; an observer of politics; a political scientist; and an advocate of greater participation of women in political office and other spheres of societies. I contested public office, though not in PNG, and I did that for a number of reasons but essentially, I saw that our chamber was unrepresentative of the community it was located. I knew many of the middle-age white male who sat in that chamber, and I knew the few women who sat there too. I attended the events that these representatives attended. I attended their sessions in the chamber. As a political scientist, I understood what they stood for. As a human and a women, I know why it is important to have a parliament that is representative of its locale. The situation in the chamber and outside left me wanting. When you have women in decision making positions, you get an insight that encompasses the ideals of those less seen or heard. These ideals translate to better policies, better communities and better outcomes for all. Women will put the needs of the country before their own. There is no need to fight for power. But there is a need to seek a just society, a society that embraces all its citizens and appreciates that when men and women share the full responsibility of building their families, their homes and their nations, they co-create better places. Women do not need to fight for power; fighting for power is ego driven. Women, we leave the fighting to men if that is how they achieve their aspirations. We work collaborative with other women and with men who share the belief that a whole nation served by men and women is better for everyone. For starters, noone needs to fight for power; we seek justice through shared responsibilities of managing the affairs of the nation. We offer ourselves to the services of the nation, we start were we are.

Great to see this blog Martha - long overdue. You might be interested in the article I published from a small post-doc project. Crabtree, Susan, and Hilary Clare Tolley. "Governance for maternal and neonatal health." International Journal of Health Governance 23.1 (2018): 4-17.

As a rural doctor for the last 15 years, I can only 'shut up' and accept these well outlined facts rather than pretending that everything is okay. We the rural majority are feeling the pinch of all these facts; while the few urban advantaged seem to be challenging the facts presented here. I wonder who they are representing.

Martha, it’s really a nice piece Your story line really denoted what was actually the sad situation in PNG health system. I am a village boy once in the 1980s, lived through with the changes in the basic service delivery in the 1990s in my youth, now am an educated father facing this reality. I have seen the reality on the ground; on the economic front, I lived to witness extremely gross and highly ignorant corruption in the country systems, basic service delivery is far than corruption. Not only in health but its right across the different sectors. Also PNG has a weak basic service delivery enforcement capacity including law enforcement body, so what in hell that we live in. Policies and programs are developed, but there is weak institutional capacity to enforce it. Now the country debts has gone up past the 35% fiscal limit so PNG is nowhere near to delivering a decent or nearly adequate basic services to its citizens. The country needs to service the debts first before funding basic services. Donor funds will not adequately address health problems in PNG. It’s the government that needs to take the lead.

I Have been working for oil, gas and mineral companies as senior medical officier for the past 6 years (western highlands, gulf, new Ireland). Some companies play the game and provide the same level of health care as their workers and families would find abroad (TB prevention, malaria, dengue, thyphoid , child and mother..). The budget put in was over 4 million US every month for health in these companies (for about 2 000 workers). We saved so many lives just thanks to early diagnostic and proper management. On another hand some companies don't play the game . I have been working for companies who don't play the game, one making over 9 billion dollars profit every year over the world and would save money over health: proud to purchase toys for paramedics and not providing proper management for TB in Gulf province. Proud to point out they had a budget of 400 000 dollars in a year when in their own country , the budget would have been around 10 million a year. Medical board is great in PNG, They should visit these sites and fine companies who don't have a proper health policy for their workers and families. A fine of 10 000 dollars for each worker not screened properly for TB (QFT minimum and Xray as needed), not vaccinated properly.....

Good article Evans thank you. Makes me sad though reading through the sad reality of our country's poor governance. Word needs to get out on how our government is letting outsiders and exploiting our natural resources leaving ordinary citizens to deal with the negative impacts during and after extraction.

I would love to take up your offer. It has been a while since I was in PNG, but I follow the health reports, newspapers and literature as much as possible. As an anthropologist who worked in PNG for forty years I feel deeply upset by the downward trend in rural areas.

Martha Spot on - except here in Western Highlands where we are making some progress as we have a great team who are committed to improving health. I invite you to come and see for yourself as being the CEO, I might be a touch biased. I cannot offer fares etc but can accommodate you in secure and friendly environs. And contrary to rumours we stopped eating babies a long time ago. So come and have a look at what can be achieved. Of course the pity is the Port Moresby narrative makes it difficult for donors to invest in the pointy end - where the action is - and many keep telling me why they can't invest here rather than how they could. I guess that has to do with career aspirations and sticking to the script.