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Seventh, effective change usually requires a commitment over many years?

The answers cannot come from outside either. What is needed is to identify the right people from within, build a company with people with same thinking to become a force of change. Removal of European apartheid regime in South Africa, for example, was a product of a 'force of determination" by one man, Madiva, from within Africa itself. Removal of American racism by Martin Luther King Jr, again was an internal solution - someone made up his mind to die for it to save to Afro-Americans and Hispanics. Some good lessons to attend to. This is not to undermine outside help, however it does mean that there has to be an internal "will" to make change.

Thanks Jacqui for a very interesting and relevant article as you also served AusAID for many years so you have both knowledge as a partner (Abt JTA) as well as a donor. As far as I know, the definition of DFAT facilities in Indonesia are not the same with the facility as what you, Senator Wong and Mr. Gilling mentioned as consolidated contracts/programs into single contract manage by single contractor. ‘Facilities’ refers to more flexible ways of doing interventions – in contrast with ‘program’ which usually has its defined outcomes and activities. ‘Facilities’ focuses more on the goal of the investment.

Thank you Mikaela, as a Papua New Guinean from the Western province, I found it really exciting to read that CHWs' work is being brought to the forefront through this article. And appreciate your passion for improved health services back home. The tireless efforts of CHWs are not always acknowledged and usually they are forgotten when it comes to capacity building programs or further training opportunities. Currently, the Australian Government through the Australia Awards Pacific Scholarships program offers in country training scholarships for a certificate in CHW Training and in-service candidates an opportunity to upgrade to Diploma and Undergraduate levels. Unfortunately, at completion of training, we’ve seen a significant drift to urban centres with their newfound enhanced skills. You have highlighted some approaches with the use of technology (mobile phones) that would really contribute to improving community health work. And if taken on board, I am sure those approaches can be very successful. I just hope all stakeholders involved in managing our health situation are optimistic, innovative, and caring to serve our people just as the CHWs do. Tank yu tru!

Thanks Yvonne

A good explanation of the problem, but the answer cannot be found within the most corrupt government in the Pacific and one of the most corrupt in the world. Nor should ICAC be introduced by this Government - there is a huge risk of fatal compromise, of which there are already signs. This government is continuing to institutionalise corruption for the benefit of its members.

great writing, great insights, keep going Busa

Hello Mikaela. Thank you for writing this interesting piece. Your passion for healthcare in PNG is clearly evident in the piece and you provide some useful examples. I have been conducting research on mobile phones in PNG for several years, including research into the use of mobile phones in the health sector. The best example of this is a maternal health hotline in Milne Bay Province. The toll-free service allows health workers in the province to call free-of-charge to the labour ward at Alotau Provincial Hospital at any time of the day or night. Information on the project, including published research, is available at: https://www.ahawatson.com/maternal-hotline . Western Highlands Provincial Health Authority established a health call centre, hiring a team of nurses to work on shifts, and making the phone number available to members of the public as well as health workers. This ambitious project did not last and I am at present conducting research into the reasons why some projects continue whilst others don’t work out. In your post, you mentioned my research in Orora village. Just a note that villagers were talking about household AM/FM radios, not HF/VHF radios, when they said that their radios were not always working. I can tell you though that there was no access to any HF/VHF radio in or near Orora when I conducted research there in 2009. Thanks again for your post. Amanda 🙂

Hi Terry. I think your raise a very important point. My article sought to defend the role of facilities – i.e. multi sector programs – in the mix of instruments that DFAT uses in partner countries. I did not intend to defend the role of private contractors versus NGOs. Once DFAT has decided to use a facility, then I think it is very important that DFAT’s procurement processes don’t inherently favour one group over another – because, of course, there could be contexts in which these facilities are best run by an NGO rather than a contracting firm. DFAT needs to choose who implements these programs based on which organisation or group of organisations will provide the best value. Having said that I do believe that DFAT run their procurement processes very effectively.

Thanks Jacqui for the thoughtful analysis of the role of private contractors. Ultimately I think the strongest argument for or against private contractors is not all the theoretical stuff above but a simple calculation: Which model has the best ratio of inputs vs long term impacts? It may be that the best model is yet to emerge: a not-for-profit body playing the coordinating role that you describe above.

This is a solid analysis of both Fiji's diplomacy and COP multilateralism, thank you for the interesting insights George.

It is good to hear that the promise of mobile health is actually working for CHWs in PNG. Do you think its use is best maximised when there is a doctor/medical professional formally available on the other end to provide regular tele-health services? Really interesting piece, thanks Mikaela.