COVID-19 and TB in PNG: a healthcare opportunity

Bogia Rural Hospital general ward, Madang Province, PNG (Gigil Marme)
Bogia Rural Hospital, Madang Province, PNG (Gigil Marme)

In Papua New Guinea, the COVID-19 outbreak has spread rapidly to all 22 provinces, affecting many people. Data from the World Health Organization (WHO) reveal that, as of mid-April 2022, more than 43,600 cases have been confirmed, with 649 deaths. The true burden is likely to be much higher as many cases will have gone unreported.

Like many other nations, the emergence of COVID-19 has been a major threat to public health, demanding resources be reallocated from other priority health issues, such as tuberculosis (TB). For example, the PNG government has approved K45.3 million to implement its COVID-19 plan, and pledged to commit more resources when need arises. Furthermore, the new TB facility funded by the Australian government in Angau Hospital has been diverted to COVID-19.

This situation threatens the implementation of the TB control program, but at the same time it provides an opportunity to strengthen the healthcare system. This could be accomplished through broader application of improvements introduced in response to the current pandemic. Such improvements would make PNG health systems more resilient against future public health threats, and better able to meet the demands of the ageing population, including the increasing burden of chronic diseases.

Across the world, the COVID-19 pandemic has created disruption in essential healthcare. People have experienced extended delays in diagnosis, treatment and provision of medications. Globally, nearly 80 million children have missed routine vaccinations for diphtheria, measles and polio. Up to 70% of elective surgeries were postponed or cancelled during the pandemic period.

At the same time, the pandemic has served as a catalyst for needed improvement, enabling significant adjustments to be made within healthcare settings. Improvements and lessons learnt in combatting coronavirus transmission within the healthcare setting include: the importance of personal hygiene practices and access to fresh water in clinics to improve hygiene; the need for physical distancing of suspected and confirmed cases in health clinics; and the critical need for available, effective and consistent use of PPE (personal protective equipment) by health workers.

In a recent media release, the WHO emphasised that the resources allocated for COVID-19 provide an opportunity to improve healthcare systems in PNG, specifically in infection prevention and control (IPC) in healthcare settings. IPC has been neglected over past decades, and COVID-19 has served as a harsh reminder of the centrality of this crucial public health activity.

The topic of IPC was recently discussed at the WHO 150th Executive Board meeting, where the Director-General submitted a report on the impact of the spread of infections and antimicrobial resistance associated with healthcare. The report identified gaps and challenges, as well as priorities to address IPC at national and international levels. These priorities include:

  1. universal availability of clean, high-quality, safe care, including for health workers
  2. IPC to be a central component of pandemic and global health security planning
  3. ensure sustainability of newly implemented (COVID-19 response) IPC programs, and water, sanitation and hygiene infrastructures.

In PNG, TB infection prevention and control (TBIPC) measures are an important public health strategy to control TB. However, implementation of TBIPC measures, such as patient isolation, triaging, cough hygiene, use of ventilation systems, and use of respiratory masks, remains inadequate in many healthcare institutions. The lack of effective TBIPC measures directly exposes health professionals, patients and the community to TB transmission.

PNG needs a substantial and sustained investment in IPC strategies. The health sector can seize this opportunity to get back to basics, to improve the primary healthcare system to create a dynamic localised system to address emerging health threats at the community level. COVID-19 has driven short-term innovation, however, it has also brought opportunity to implement long-term change that can be maintained post the COVID-19 crisis. There is an opportunity to reform a flawed healthcare system in PNG, for the benefit of all Papua New Guineans.

COVID-19 continues to spread around the globe. IPC and other socio-economic policies adopted by countries will be critical in determining its impacts, and enabling local, national and global recovery. The pandemic threatens progress of the WHO End TB Strategy, yet COVID-19 could be the catalyst to reach the WHO target of eliminating TB, by improving IPC strategies in healthcare institutions.

COVID-19 has heightened awareness of IPC and created momentum for innovation in the PNG health system. The lessons learnt in combatting the coronavirus provide an opportunity for the health sector to refocus TB control, and to develop a strong, more resilient health system to both cope with emergent public health threats for the coming decades and deal more effectively with endemic health problems such as TB.

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Gigil Marme

Gigil Marme is a lecturer in public health at Divine Word University, Papua New Guinea. He is currently studying for a PhD in Public Health Policy at Griffith University, Australia.

Neil Harris

Neil Harris is Director, Higher Degree Research for the Health Group, and Professor of Public Health within the School of Medicine at Griffith University.

Peta-Anne Zimmerman

Peta-Anne Zimmerman directs the Graduate Infection Prevention and Control Program at Griffith University, and is a member of the Menzies Health Institute Queensland and visiting research fellow with the Gold Coast Hospital and Health Service, Australia.

Shannon Rutherford

Shannon Rutherford is an associate professor of public health in the School of Medicine and Dentistry at Griffith University.

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