Comments

Camilla, that’s a very interesting pieces of interview. Others may share their views on the interview but one important concern that we can raise on RJIA project into community in Pogera or elsewhere is “sustainability” of such community project. Even if there are women volunteers breaking the barriers to promote, advocate and bring to justice the social issues, how long it can be sustained and built on is the concern. Hope Everlyne and her RJIA gets support from Laiagam Pogera DDA and the District Administration with funding and other formal support to continue their community project. Barrick Gold funding support cannot be seen as sustainable.

Hi Somandin, Thanks for your comment. You raise an important point - as more students enter primary school and then progress into secondary school, what can students expect to do once they finish grade 12? As you say, these reforms should also provide students with pathways for continued development beyond secondary school. The TFF does fund vocational education and training but as a policy it does not connect with the higher education sector. Is this "access cliff", where large numbers of secondary school leavers cannot get into university, the best approach? Open distance education will help to a degree but it is not a close substitute to direct university education as far as I can tell. Perhaps a better approach is to not completely do away with academic standards for entry to secondary school, thereby limiting numbers until the capacity of the entire education system (including universities) can handle higher growth in student numbers. There are important trade-offs that are implicitly being made in PNG's education policy. These trade-offs should be more openly acknowledged and discussed, and broad agreement reached on what is the best approach to take. Tony

in the early 1990s there were also some changes to the lower education sector. these changes includes the reform from non-formal tokples pre-school to elementary school, community school to primary school and provincial high school to secondary school. whilst the GoPNG concentrates on these reforms we forgot that the actual out put of this reforms will be the input to the tertiary education sector. after 10 years and on-wards we are seeing the effects of this reforms by having the number of our grade twelves increasing and many missing out on spaces in the tertiary education sector. with the current TFF policy and the removal of grades 8 and 10 exam will only make it more challenging for us to absorb ever increasing number of students. these reforms are not bad for the country but are things we want and planned for, but we have failed to strike a balance in reforming our tertiary education sector to match the expected outcome of our reforms. recommendation. the GoPNG should now concentrate on providing quality to the lower education sector and improve excess and quality in the higher education sector.

The highway to hell starts from paradise... Bri has a point of contention with what happened out there, but going back to PNG, we have this "block voting" active and alive, opposed to party line. Tribal, marriage, and customary alliance is still active.. minus the anticipated party manifesto. This election might go with the latter.... We hope for changes, but the current government has 'institutionalised' itself like nothing seen before. If the fraud court cases, task force sweep, student protests.... all fell shot of achieving an outcome. The chances of this government returning to form the 10th Parliament is looming.

I think there is no guarantee in funds commitment to such abrupt statements, until done otherwise. In fact, aid posts here have not dwindled but all shutdown long time ago, because of funding. If state facilities are hard to manage, church-run facilities operate better in rural settings, we just need the DSIP and PSIP monies diverted to them. In stead, the devolution of powers through the DDA Act gave open checkbooks to District Administrators and District treasurers at their disposal. Some of them leave no traces... while rural clinics remain closed.

Australia's two Parliamentary Committee reports mentioned above, recommending that our government provides additional resources for nutrition programs in the Asia-Pacific region, is indeed heartening. As with many written tomes, the words are impressive. While most lucky Ozzies - including politicians - plan Christmas dinners, those abhorrent high rates of malnutrition and stunting in our neighbouring countries' young children, should make us all determined to see those impressive words put into practice during 2017.

Well said the commentaries What the current situation at the health centres and the numerous difficulties faced by mothers and sisters in rural and urban centres are explained well by Dr Mola, the PM should read this. The idea on compulsory push for mothers to deliver babies at a health centre will not improve on maternal and child mortality rate of this country. Many socio economic policies initiated by current government already proved to fail (free health and education policy, compulsory basic education for school age kids, SME) so this proposed policy to push all pregnant mothers to a health centre for delivery is an unrealistic option. The real problem is meeting the needs of the health centres to competently deliver services and improve the health indicators envisioned by PM. Basically the PM should not think hard but categorise them into three basic approaches; (1) build health centres with adequate space & facilities, (2) upscale skills and manpower of staffing and (3) procure & supply appropriate equipment/drugs for health centre, then the PM’s dream of improving PNG maternal and child health will bear some fruits. The answer to the problem is not with Cuban doctors, do not take the fight too far into the Caribbean but back to Waigani, Treasury, Finance and to specialist like Dr Mola for advice.

Thanks Collin, I am proud to be part of the team on the ground....thumbs up!

Thank you Professor Mola, your insights should be one of consultation by the PM. Many of your colleagues, knowledgeable in the issue seems to be left in the dark as well. PM may have a great vision but it needs to be founded in reality.

Congratulations Nematullah. This work provides an excellent insight into the complexities of sovereign aid motivators. I am interested to know more about how transparency is perceived as a tool to portray a nation as having sound governance, in an attempt to attract future funds; whilst, as mentioned in your article remaining corrupt. Transparency needs to be deeper than just providing information, confidence in the information's compilation and motivation needs to be considered. A great read. Best wishes.

Glen Mola has provided an excellent outline the complex challenges ahead if PNG is to reduce maternal mortality. What he accurately describes is the weaknesses in the maternity health system, that is about to become considerably weaker with a planned 60% reduction in revenue (USD equivalent) for the foreseeable future. There has been only a muted response to the magnitude of this humanitarian crisis so far, as outside donors and observers move to protect their slice of the health development program, the wider health system crisis that is under way is being largely ignored. No health system can sustain revenue reductions of this magnitude, and hope to maintain service levels or make improvements . As PNG is home to 77% of the Pacific Islands' population, the chances of this sub-region reaching the health SDG by 2030 is already slipping away. The PNG PM has provided very necessary focus to this ongoing challenge. However, solutions that have been developed within the PNG context are more likely to be successful than those form outside. In this respect, Glen draws attention to the Milne Bay experience. Milne Bay is worth a closer look. Milne Bay is a high performing and consistently improving province in the PNG health system. It also has geographical and demographic features that are typical of the health service challenges in Pacific Island health services – with both remote hill country, a town (population 12,000), and populated, widely dispersed islands. The total population is 280,000. The reasons behind Milne Bay’s success include a combination of factors. Consistent with the complex nature of health systems, it is unlikely that any one feature is “the magic bullet” - more likely the combination of factors and their positive synergistic interactions. The wider context includes Milne Bay provincial administration as one of four consistently higher performing provinces in PNG. ( NEFC 2013) It achieves this despite relatively low levels of provincial revenue: It has a level of service closer to the cost of service estimate for health than many other provinces, including those with more resources. Milne Bay has had consistent, skilled health leadership over an extended period, demonstrating exemplary management of the key relationships, and through this facilitated resources and support flowing to the province from both donor and government sources. Interviews I undertook in 2015 revealed skilled relationship management of important provincial and political stakeholders. Within the Milne Bay health sector, there was impressive clarity of vision across the different health cadres. The 2015 interviews revealed a shared culture and understanding of the role of the health system's Provincial Health Authority across all layers of the organisation. This included a high level of commitment from senior clinicians to the overall health objectives of the province. To quote a senior hospital specialist: "I am responsible right down to the aid post". This leadership has also enabled / encouraged partnerships with donors and other actors. This includes the churches, independent NGOs (Dr Kirby being the prime example ), major donor initiatives (such as Rural Primary Health Service Delivery Program where implementation barriers have been overcome that slowed progress in other provinces). It has also received considerable financial and technical assistance from DFAT and its predecessor AusAID over an extended period. The 2015 interviews with the CEO also revealed his focus on managing the relationship with the NDoH, especially around issues of funding and funding flow. The latter plagues the PNG government system, exacerbating the shrotage of the former. An analysis of the level of hospital spending reflects the success of this focus. Alotau hospital grew its share of national and provincial hospital funding from 4.79% to 5.9% over a three-year period 2011-2013, a greater shift than in any other province. An important indicator of health system access is the number of outpatient visits occurring. An analysis of PNG’s 89 districts shows that 3 Milne Bay districts (Alotau, Esa’ala, Kirwini Goodenough) were in the top 6, with the greatest improvement in this indicator. There have been major barriers to family planning services in PNG. Recently, Milne Bay has piloted the use of contraceptive implants (particularly in Kiriwina Goodenough) and between 2013 and 2015 this has doubled the use of contraception in this district. This far exceeds the improvement in this indicator nationally, and will have profound downstream impacts such as reduced maternal and child mortality, and significant economic and wider social benefits in the medium term. Improving supervised deliveries, the PMs current focus, is a complex task in health system strengthening and Milne Bay has outperformed the rest of PNG’s provinces in this regard, with a 23% improvement over the period 2011 to 2014. As noted earlier, this excellent result is due to a combination of core government, NGO, MP, staff and community engagement. The latter being engaged in the demand side with the provision of ‘baby bundles’ supplied by an NGO. A high level of success is also seen in other areas (see 2015 PNG SPAR report). Milne Bay leads the country in outreach clinics for children, immunisation levels (measles and DPT3) and TB treatment success levels. It is also in the top three provinces for supervisory visits, and functioning telecommunications. It has low levels of diarrhoeal illness and low rates of pneumonia deaths of children in hospitals. Despite the successes outlined, Milne Bay also faces very big challenges. It has the nation’s highest levels of malnutrition in children (40% and likely to have deteriorated further with last year's drought conditions), malaria (despite improvements), and it ranks 16th among provinces in availability of supplies in clinics. In conclusion the evidence above suggests there is considerable value in describing and sharing the experience of Milne Bay province more widely across PNG. The evidence suggests dynamic improvement and leading performance within the health sector, enabled by strong performance in the province. This has enabled the effective mobilisation and utilisation of resources and adoption of innovations. It is likely these positive management and leadership conditions have been operating over an extended period (10years+). There are also unmet challenges in conditions such as malnutrition, malaria, and NCDs where effective an intersectoral approach is paramount. The potential to address these deeper issues is readily visible in the existing relationships, and will provide valuable lessons on how intersectoral approaches can be tackled in PNG more generally. The Milne Bay experience has much to offer at the political, governance, management, clinical, and program levels. However, even Milne Bay will struggle to survive the level of reduced health expenditure that is occurring. Don Matheson. (reference material related to this post available from donmathes@gmail.com).

Thank you, Susan. Complex is definitely the key word here!