Comments

Thanks for the reply Paul, but I must say I don't think you understood much of what I said. You ask what the alternative is to having a perfect cop-out. The alternative is to take responsibility for policies. The second sentence of your first para ("You are also right...") appears to have no connection with anything I wrote. I never mentioned donors' "political objectives" or any "fickle or ignorant electorate." "To make generalised observations about such a broad topic as ‘culture’ is always going to offend some who have differing perspectives." Yes, it is offensive to say, as PNG specialists in effect do, "Your culture is inferior to mine" but you miss my point. My point is that culture is irrelevant. Just irrelevant. Culture has nothing to do with PNG's problems. The juicy details of the exotic culture are immaterial to PNG's political difficulties. Your assertion that Australia had no choice in what they set up at independence is incorrect. They had the choice of every political system in the world. But they stood back and allowed the local politicians open slather. The politicians then set it up to ensure they would have permanent open slather. The constitution committee, composed entirely of members of the PNG House of Assembly, set its own rules. Where did they get the idea of having single-member electorates with a single house of parliament? What were their models? The only Australian example was Queensland, the most corrupt state in the country. New Zealand had abolished its upper house in 1950 and was having deep regrets. Geoffrey Palmer, later PM, called NZ an elected dictatorship. The only other democratic country that had this structure was Northern Ireland which was in turmoil. Mauritius had tried it and it had failed and it was catastrophic in Africa. Why did the PNG committee adopt a structure that no country has ever made work? That question is rhetorical: it was a power grab. Australia permitted this and it is a tragedy. This is not wisdom of hindsight. I am describing the situation at the time. There are good technical reasons why single-member electorates along with a single legislature doesn't work. For example, in 1965 the Nobel Prize winning economist, Sir Arthur Lewis, wrote "Politics in West Africa," predicting terrible consequences of this design and he suggested multi-member proportional representation. Prominent political scientist, Stephen Lukes, said at the time that Lewis was right and further predicted that no one would take any notice. Lukes was right, too, and it came to pass that tragedy was visited upon millions. Back in 1921 when the UK government created Northern Ireland, they must have understood it for they installed multi-member PR even though PR was virtually unknown in British politics. Unfortunately, a few years later they buckled to Stormont's—the local MPs'— demands to change it. Thus, like the PNG politicians fifty years later, the incumbents made the rules to suit themselves and so launched NI into two generations of misery. After the "troubles" started about 1970 the UK government realised they had to revert to PR. It took three attempts before they could get it to stick—about ten years ago. "PNG politics is starting to come of age... ...the resilience and fibre of the PNG people" Whatever the source of such pap, you should strike it off your reading list. "objectives must be practical and achievable" Yes, and motherhood is also good. Nothing will be achieved until the political structure is rectified. Neither the locals nor foreigners will succeed. It has gone backwards since 1975 and further decline is a sure bet. It will be compounded by more of the resource curse. Australia can prop up the Solomons and Vanuatu indefinitely but Australia's influence in PNG will wane as mineral money moves in. When the chaos in NI got too bad the UK government sent in the troops. Australia can't do that with PNG. At some point the colonels will take over. "imposed political systems didn’t meet local objectives." The political system is still there and will never meet any country's objectives. It will only meet elected MPs' short-term, personal objectives. "Today’s modern and educated PNGian now has an opportunity to make changes for the future based on the knowledge of what works" As I say, do ditch your source of such fatuity. It is exactly what is not the case. Your m and e PNGian has no chance and never will till the constitution is fixed. Either an upper house or (better) multi-member electorates. "as far as Melanesian culture ‘evaporating’ as a significant factor in PNG politics, I beg to differ." You are not begging to differ with me but with a straw man. I said that if PNG had a viable political structure its culture would evaporate as a conversation topic. And it would. Consider Northern Ireland. NI allegedly had a huge culture problem: Catholics versus Protestants, at each others' throats for centuries. It exploded again around 1970 and for decades we, in Australia, heard about the Catholics and the Protestants of Northern Ireland in nearly every news bulletin. Do we today hear those news bulletins? Vanished. Evaporated. Why? Because they (the UK govt.) introduced multi-member PR. The culture, and 70 years of political outrages and sectarian bitterness, didn't evaporate; the Cs and Ps are still there and they surely didn't suddenly decide to be best friends. How has this sudden peace been achieved? By installing a political structure that has been known to work. Three thousand people died in the Irish "troubles." Did they die because of the religion, because of the culture? No. They died because the electoral system was faulty. Had the electoral system been multi-member PR they'd be alive today and their families and the rest of the world wouldn't know anything about any troubles. So all that talk about Catholics and Protestants was irrelevant. Utterly irrelevant. Similarly, PNG would today be a prosperous country with a sound infrastructure if Australia had taken its administration duties seriously. No one today would be alleging that it had an inferior culture. Culture is irrelevant: nothing in the new Irish PR reflects those two religions and nothing in a putative PNG PR would reflect its alleged cultural features—just as, indeed, there is no reflection of the culture in PNG's present dysfunctional structure. Culture is immaterial to political structure. It is just a red herring. In the case of PNG the blather about culture is arrogant and self-serving but it wouldn't matter if it were flattering. Culture is irrelevant.

Hi Mike, I agree with you about AusAID always having the perfect cop out on why their policies aren’t working yet what are the alternatives? You are also right about other aid ‘givers’ being able to direct their aid in ways that enhance their own political objectives without having to be answerable to a fickle or ignorant electorate. To make generalised observations about such a broad topic as ‘culture’ is always going to offend some who have differing perspectives. The political system bequeathed to PNG at Independence was not in any way tailored to the accepted norms of the day. It was only accepted by the ‘Norms’ of Canberra and the UN. Australia just did not have much choice about what it set up given the accepted methodology of those who dabbled. Those who inherited the system also didn’t have much choice as well. I suggest that PNG politics is starting to come of age. Every nation goes through a political learning curve and PNG started a lot later than some. It is indicative of the resilience and fibre of the PNG people that they are moving forward politically a whole lot faster than other nations who started out a whole lot sooner and have come to grief. I agree with you about the conferences and seminars that only provide a few high priced consultants with self-actualising methodologies and a few locals with a free lunch. The only way around that oxymoronic, ephemeral outlook is to have pre set defined objectives and an effective feedback loop to ensure the objectives are met. Of course the objectives must be practical and achievable otherwise if you set a target predicated on BS you’ll undoubtedly be able to easily achieve your aim. I believe PNG is on the cusp of breaking through the culture clash of the past where imposed political systems didn’t meet local objectives. Today’s modern and educated PNGian now has an opportunity to make changes for the future based on the knowledge of what works and what doesn’t. That opportunity was not previously available in a PNG context. However, as far as Melanesian culture ‘evaporating’ as a significant factor in PNG politics, I beg to differ. While ever 85% of the population is still living in a rural existence without any real recourse to any other way of life and general education opportunities only now starting to be resurrected, the culture of the clan and tribe will be prevail.

So they found four factors that are "massive inhibitors of development." You say you find them compelling and you talk of the first of them: the culture one. You mention "...extreme historical, geographic and cultural diversity... absence of any strong sense of national identity and by weak political and social cohesion... Informal institutions prevail over formal institutions. Politics is shaped by the ‘big man’ culture..." I think all this is irrelevant. Everyone talks about PNG's dysfunctional culture. What is your employer, AusAid, going to do about it? Nothing. No one expects it to interfere in a foreign county's culture. So why talk about it? Because it is the perfect excuse? Because no matter how ineffectual AusAid is, it can always blame the victim? My culture is superior to your culture—this is the core of colonialism. I submit that it is actually incorrect and that, given a chance, Melanesian ambitiousness would sustain a flourishing democratic polity. But it has no chance. "Second, we may need to accept that the issue in PNG is not about the volume of aid but about how we can change institutions and the incentives of politicians." Yes. Commenter Paul Oates says to learn from history. He's right but not regarding his preconceptions of culture. The history lesson concerns institutions and is very clear: a majoritarian electoral system is poison and combined with a single chamber of parliament it is deadly poison. At present Vanuatu, the Solomons and PNG are competing to be the first country in the world to create a viable polity with single-member electorates and a single chamber. If they pull this off (despite their inferior cultures) they will succeed where New Zealand failed, Mauritius failed, and Northern Ireland failed. At the time PNG was being set up, New Zealand was regretting abolishing its upper house two decades before, Mauritius was under a state of emergency, and Northern Ireland was in flames. Failure to learn from history, indeed. In a post on 5.10.12 Christine Stewart reckons the fatal flaw is the power of the speaker. No. That is just a particular manifestation. Fix that and there'd be something else. With an upper house the lower house speaker would be neutered and all those cavalier laws would be subject to a second debate. There are twelve established democratic countries which have a single parliamentary chamber. They are successful--but all of them have multi-member electorates. NZ and NI are now among them. PNG culture is beside the point. PNG is afflicted with a political structure that does not work with any culture. "Third, we should (finally) give up the assumption that ‘building the capacity’ of individuals and organisations in the government will make a difference to service delivery on the front line." Absolutely. All this does is sustain useless courses and conferences. As long as the institutions and incentives are not right it is plastering over the cracks and ignoring the foundations. You say "Our objective here could be ‘stability at minimum cost’." When the junta takes over the cost will be incalculable. Your fourth and fifth points, admitting the state has failed, are proposals to run it for them. It doesn't sound like much of a plan for a country of seven million. Give a million dollars to each MP? Does wealthy Australia work by bribery? To mining companies a million is small potatoes and when they are ready, the Chinese bribes are going to make it appear paltry. A premise of your post is that donor money talks but when the time comes the politicians will probably be able to thumb their noses at donors as insignificant. For wantoks to morph into citizens simply introduce multi-member electorates. There is no prospect of a "journey to statehood" while they have a non-viable political structure. They are on a journey to civil war or coup d'etat. In hoping for this morph I think you have a change of culture in mind. Set up viable institutions and the culture will evaporate as a conversation topic. Says Tony O'Dowd: "The real question is why do donors end up selecting governance modalities in PNG that have consistently been shown not to work" He makes various plausible suggestions but I think it is pretty simple: AusAid and academics specialising in the Pacific are doing fine. Advocating such a radical thing as changing the constitution is disruptive and any individual who does it will be disapproved of. Yet it is essential. It is the lesson of history.

Good comments, Jo. You are certainly right in saying that Governments need to invest in primary, secondary and tertiary care for all sorts of reasons, including public health, ethical, and political reasons. The question they face is, what is the "right" balance, given growing needs and constrained resources. There are certainly some expensive and technically complex operations that can only be done in hospitals - and possibly even overseas - that are justified on public health, public finance, and ethical grounds. Surgery to repair a hole in the heart (an NCD, but one often arising from rheumatic fever) for young children would often fall into this category. That is because it restores a young person to essentially good health. Removing cataract blindness, if necessary in a tertiary hospital, may also be entirely justified on public health, public finance, social, ethical and other grounds. But there are other examples where so called "curative" treatment at the tertiary level is hard to justify, other than on political grounds. The report shows that dialysis treatment in the Pacific can be very expensive in absolute and relative financial terms to Government, whilst being of limited effectiveness in terms of extending life (around two thirds had died within two years). Perhaps most importantly, expensive dialysis treatment in response to diabetes related kidney failure carried very high "opportunity costs". That is, every one thousand dollars spent on expensive but largely ineffective dialysis on an (often elderly, and often not particularly poor) dialysis patient was then another thousand dollars that then could not be spent on more cost-effective interventions, reaching many more poor people, to meet their needs, including immunisation, family planning, and other basic health services. As you very correctly point out, this all involves very difficult policy choices and trade offs for governments. My argument is that better and more effective primary and secondary prevention is often likely to be more effective, and equitable, in terms of health financing than some end - of - life 'curative' treatments at tertiary hospitals. And to the extent that primary and secondary prevention is effective it will also reduce - or at least postpone - over time the costs associated with treating complications of NCDs at the tertiary level. Thanks again for your thoughtful comments.

Thanks for raising this significant issue. I like the fact that you point out the strategic approach can have 'win-win' consequences. My comments may relate to what was said in the video, which I am unable to watch due to data limitations. So my apologies if I am repeating what is already said. It seems to me that one of the issues regarding finances is that governments actually need to invest simultaneously in health promotion/primary prevention and secondary prevention (in order to prevent future NCDs and the progression of disease in those with early risk factors or disease) and tertiary care for those who already experience the consequences of advanced disease. There are difficult trade-offs to be made and the people who will die if they don't get dialysis (for example) often have an emotive pull over those who do not yet have signs of disease. Further, this is not merely a challenge for any country's health system. It is multi-sectoral, related to wider issues, such as income, land access, education, gender roles, and cultural perceptions surrounding body size and image (to name a few). Addressing NCDs and their risk factors requires social and economic changes. To my mind, it is certainly a 'wicked problem' that requires a whole-of-government approach and coordinated action. I will read your report with great interest.

Ian, thanks for this amplification. Will look forward to learning more about this very important topic.

Thanks Tess for your thoughtful comment. There will always be more demands for health care than there are resources, so in that sense there is a conflict. However I think the more important point for Pacific Islands is that with limited resources ("fiscal space") Governments have to use their resources in the most effective and equitable way. The report shows that some governments in the Pacific allocate quite large shares of their scarce resources to very expensive, and not very effective, "curative" care, often in hospitals where costs are higher. The argument I am making in the report is that reallocating scarce resources to primary and secondary prevention at earlier stages in the diseases will be a more cost-effective approach than end stage "curative" care, and improve public health more broadly. Being more affordable, primary and secondary prevention will also be able to treat more people as well. But even then, there will always still be budgetary and other constraints (eg availability of skilled health workers) to address needs.

Thanks for this post Ian, it raises some very important points. However, I can't help feeling that within your 3 points above, the third is largely contradicted by the second. Yes there are significant financial and economic benefits to focusing on primary and secondary interventions to manage risk factors but if the 'fiscal space' really is that limited then is this actually achievable?

Hi Stephen, Thought your response was worth a quick reply though a chat over a coffee might be more effective. The most evident error in your blog, which I thought was clear even from my rushed response, is that Australians need not be involved in all ACIAR funded projects. And I am not sure how a competitive process would ensure the involvement of the limited best developing country researchers as ACIAR projects have. On the benefits question, which I said flow automatically from the collaborative model, recently taken up in AusAID's recent AIP Program, this is appearing in the UK aid debate at the moment. The position to not cut aid whilst domestic programs are being cut is being defended on the grounds that such aid delivers the socio-economic benefits to the UK that ACIAR requires to be estimated ex ante in its projects for all countries and formally measured by independent assessors ex post. Best regards Ray

While I congratulate the PM and his Government, I want to post this comment regarding the 2013 Budget. The budget still does not address the needs and aspirations of ordinary Papua New Guineans today. About 75 per cent of it is based on assumptions and not deducted facts and figures due to several reasons. One of these is that its intial framing never considered the principle of putting the last first which is only possible through a bottom up planning and participatory budgeting approach. I think the government has not been placing value on data and information.

Thanks John for this post. I think this topic is an important one not only for PNG but also for other Pacific island countries. I think one of the most significant hurdles to supporting informal economic activity is a lack of information, by its very nature it is difficult to map and quantify. Some countries (e.g. Solomon Islands) are now taking steps to include questions in their Household Income & Expenditure Surveys which attempt to capture some of this information which is one step in informing policy by governments and development partners.

Thanks for your comment, Ray, but I must say that I couldn't find the errors you identified, and nor do I think we wrote from a narrow (let alone an AusAID) perspective. Unfortunately, you make an error by saying we suggest "the mutual benefits rationale" is important "over" development. What we say is that ACIAR adopts a mutual benefits rationale (that projects should benefit both the developing country and Australia). It does this so often and so pervasively that I thought it was in its legislation. It isn't. ACIAR is the only part of the aid program required to justify its spending in part in terms of benefits of commercial benefits to Australia. That's unfortunate. Downer dropped the commercial objective back in 1996. ACIAR should catch up with the rest of the aid program. This is not to say that some projects won't have commercial benefits. But it shouldn't be the objective. Second, I take it you think ACIAR should continue to require the involvement of Australian researchers in all its programs. Again, the rest of the aid program has made, not complete, but considerable progress in terms of untying over the last 15 years. As we say, there are good arguments for continuing to link to Australian researchers. And there are certainly good arguments for encouraging collaborative approaches, as you show. But there are also good arguments for, as we put it, "encouraging ACIAR to seek out the best researchers wherever they are, rather than the best Australian researchers. For example, ACIAR might open a competitive funding window which would be available to researchers worldwide." I'm surprised you implicitly dismiss this argument without considering it directly. Think of AusAID's ADRA: the best Australians compete against the best from other countries for the Australian development research dollar. As you have pointed out, there are lots of good Australian agricultural economists, and there are no doubt many good Australian agricultural scientists as well. They should do well in a competitive process. In summary, requiring ACIAR projects to provide commercial benefits and tying all projects to the involvement of Australian researchers are unfortunate, and one might say narrowing, or even protectionist, features of ACIAR's work. That was the argument of our submission, and I don’t see anything in your response which convinces me that we were wrong. None of this is to argue that ACIAR does not do good work, or that AusAID is somehow better. I have more than once argued for more funding for ACIAR. But the aim of the Farmer Review is to look at what can be improved, and that was the focus of our submission and post. Thanks again for your response. I'd be interested to hear what others think. Stephen.