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A compelling piece. This is where democracy fails miserably. Seven hundred languages and 1000 different cultures, like it or not, you need something more stringent, more controlled, precise and tough to get things moving in the right direction for the benefit of all.

Thanks for your timely and important insights Martha. I really wonder how to maintain visibility on this human catastrophe. And beyond that, how to get action out of visibility. I published a piece on the PNG health/medicines crisis in the New York Times late last year, figuring that the APEC moment was ripe to put these into the frame. The story set out to join the dots between corruption and the total breakdown of the medicines and medical supplies systems, and the shattering human consequences of that. Which were and are absolutely explicit (under underlined by some punchy quotes from Stephen Howes joining the dots on Australian political squeamishness and Manus). And it got ... zero traction. (Story was here fyi https://www.nytimes.com/2018/11/13/world/asia/papua-new-guinea-apec-polio-health-crisis.html)

Terrence Wood, Great piece, it accurately reports the system and how the governments of both PNG and Solomon Islands have deteriorated post-political independence. For us to see changes, these countries must vote new and educated leaders with a new way of thinking and with respect to the rule of law and to accord respect to the sanctity to parliament itself and the responsibility it must hold for its citizens. Having said that, both countries must start to do away with pre-colonial leaders who have somehow used politics to amass wealth to mismanagement of states assets and funds. The core of this problem is the system of government these countries have adopted or were forced to adopt (Westminster system of government), for example in PNG'S case -- and I assume the Solomon Islands -- is no different. I have lived in both countries and I can remember some of our leaders, like Sir John Guise, clearly preferred a system of government that decentralised its powers to the provinces and local level governments. This was to address the vast diversity of peoples of PNG and make them more accountable. However, in PNG'S case, the Australian government was advocating a system like their very own where Canberra is in charge. Eventually that was the system adopted by PNG. Both countries also suffer from a form of pre-colonial influence. Australia must learn not to meddle in PNG'S affairs especially in the area's of minerals and its resources where there is basically next to no policing of the environmental damage by its company, Rio Tinto and others under different names. In the system of government proposed by Sir John Guise, aid would be sent direct to the provinces and their government for their original intent and purposes. This would stop the current Prime Minister and his gang of robbers from laying their hands on it. All they would get instead is a piece of paper saying the funds had been received by the province and being used for their purposes. This is where the decentralised system would have worked for PNG not the system we have. But I guess Canberra wanted this system so they could still keep a colonial presence asserted through economic partnerships. The one big negative to that is the Ned Kelly's in Waigani have worked out a way of diverting aid into their own pockets. You don't have to look far. Starting from the founding leaders (with due respect) right across the board. How did these people become overnight millionaires? They have manipulated our system, using that clientelism you mention to their advantage, proving that system does not suit the Melanesian way. The Presidential system perhaps is the one for us? Anyway, it is great that a postmortem has been done on these countries, the challenge now is in fixing them and definitely not with more aid to Waigani or next to the old G Club in Honiara. Peace.

Great post Adela and Warren, and really good to hear about these plans. As someone who just returned from a wonderful holiday to Vanuatu (spending time in Vila/Efate and on Santo), I was really impressed with the ease of travelling in Vanuatu, the high level of safety (especially as a single female traveller on my own), the friendliness and welcoming nature of Ni-Vanuatu people, and the accessibility of beautiful natural attractions. On Santo in particular, I was also really impressed with the commitment of local communities (Port Olry being one example) to environmentalism and keeping the natural environment clean and pristine. So everyone in my circles is hearing about how great Vanuatu is for a holiday! One thing that as a development-conscious traveller that I would have liked to have been able to do more of would be to support locally-owned and operated accommodation providers. Having spent many years living and travelling throughout Indonesia, I was surprised that everywhere I stayed in Vanuatu was expatriate-owned, with all but one venue managed by an expatriate as well. No doubt this still creates jobs and supports the economy so these accommodation providers are still making a positive contribution. But there are travellers looking for ways to better support the communities they visit. So it would be good if there was a way for travellers to identify Ni-Vanuatu owned/operated accommodation options, tour providers or restaurants. I also noticed the demographic of travellers to Vanuatu from Australia was on the whole a lot older than Indonesia or SE Asia (just from observation not data). Cost might be one issue (a hard one to overcome) but I think some of these proposals around soft adventure and eco tourism would be of particular interest to the younger demographic — promoting these to the right groups in tourist-sending countries will also be really important.

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.