Working together to get back to basics--finding health system solutions

This paper highlights the key changes to the health system over the past 20 years, including the impact of the Organic Law on Provincial Governments and Local-level Governments, the politicization of the system, the changing balance between government and development partners in financing the health system, and the development of a sector-wide approach in the Papua New Guinea health sector. It discusses reform efforts at bureaucratic and regulatory level to address these problems. Key health sector policy issues and lessons learned over the past two decades are highlighted. The paper concludes with an examination of what is needed to 'get back to basics' through mobilizing all health sector partners with the aim of getting the health system delivering improved health outcomes.     

Communication in the field: the aid post orderly and the health extension officer

Following Independence in September 1975, extensive decision-making authority has been given to provincial governments in Papua New Guinea (PNG). This includes many aspects of health services for the rural sector which comprises some 80% of a 1982 population of approximately 3.16 million. The development of Health Centres and Health Sub-Centres, administered by Health Extension Officers upon the existing datum of Aid Posts and Aid Post Orderlies, has promoted rural health services. This, in conjunction with the decentralization of health administration to the provinces, has generated changed health expectations and newer problems. The paper discusses the situation using examples from an isolated area of the Eastern Highlands where a new Health Sub-Centre was opened in 1981, and makes some suggestions from these observations.     

江苏省县（市）级综合医院建设现状调查报告

为了贯彻落实中央医改精神，加强县（市）医院建设，江苏省医院协会受省卫生厅的委托，对全省县（市）级综合医院的建设情况进行一次全面调查，以便摸清江苏省县（市）级综合医院建设家底，找出存在问题，研究进一步发展县（市）级综合医院的思路和政策措施，制定《江苏省县（市）级综合医院建设标准》。     

Social determinants of health: from observation to policy

Differences in the health of individuals reflect inherent features of the societies in which they live. The way a society organizes itself and delivers wellbeing to its members are major determinants of health. Social, economic and political factors have an important influence on health and longevity. Social position and lifestyle only partially explain ill health. Psychosocial factors, such as a sense of isolation, deprivation or loss of control, are also important. Governments can reduce health inequalities by ensuring that all policies are assessed for their potential impact on the health of all sectors of society.     

Demography and the epidemiology of disease in Papua New Guinea

Papua New Guinea (PNG) remains a predominantly rural society. Declining mortality but only slow decline in fertility has led to an average annual growth rate of the order of 2.8%. If fertility continues to decline slowly, the population will reach 10 million soon after 2029; with an accelerated decline the population will be about 8.9 million persons in 2029. Wide differentials in mortality among provinces indicate considerable variation in mortality change. Infectious diseases which dominate the cause structure of mortality should be susceptible to health service intervention. Prerequisites are an appropriate mix of interventions, high levels of coverage, and high-quality monitoring and surveillance. It is critical that these unsolved disease problems be fully addressed as the combination of increasing urbanization, the AIDS (acquired immune deficiency syndrome) epidemic and an increasing prevalence of non-communicable diseases will place upward pressure on mortality rates. For the purposes of monitoring mortality change health services need access to methods for the calculation of mortality rates which have been validated in populations in PNG. Perhaps the most fundamental task of health services is to prevent unnecessary deaths. This article focuses on levels of mortality and the cause structure of mortality. It examines the relationship between health service interventions and mortality decline in PNG.     

Looking down the barrel of a cannon: the potential economic costs of HIV/AIDS in Papua New Guinea

The HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) epidemiological model for southern Africa appears to fit data available for the Papua New Guinea (PNG) experience to date. Using certain aspects of the southern African experience, we can create some scenarios for the potential economic costs of HIV/AIDS in PNG. The first part of this paper surveys relevant literature that reports the economic impact of HIV/AIDS in southern Africa, primarily in terms of the microeconomic (health system) and macroeconomic (economy-wide) costs. The second part of the paper presents alternative scenarios for PNG at the micro- and macro- levels, both of which are grounded on the southern African experience.     

Cannabis in Papua New Guinea

Cannabis is the most commonly used illicit drug in Papua New Guinea (PNG). Data on the epidemiology and history of cannabis in PNG are presented. The adverse health consequences of cannabis smoking and treatment options for cannabis dependence are discussed. It is recommended that a range of strategies are urgently required in PNG to prevent adverse physical and mental health consequences associated with cannabis smoking.     

江苏省基层医疗卫生机构改革成效研究

背景　基层医疗卫生机构是我国医疗卫生服务体系的网底。江苏省自2014年开始实行综合医改,2015年作为全国4个率先进行省级综合医改试点的省份之一,全面启动医改工作。目的　了解江苏省综合医改试点前后基层医疗卫生机构财政投入、队伍建设、能力建设调整情况,为江苏省基层医疗卫生机构改革和发展提供建议与支持。方法　数据来源于2012-2016年原江苏省卫生和计划生育委员会调查表,研究开展时间为2017年10-12月。分别从卫生资源条件、医疗服务产出2个维度来评价基层医疗卫生机构的改革成效。选取的卫生资源条件评价指标为财政补助收入、基层医疗卫生机构数量、床位数及卫生技术人员数;选取的医疗服务产出评价指标为医疗收入和药占比、诊疗人次、入院人次。以2014年各指标数值为基础,通过计算定基比分析各指标的变化情况。结果　2012-2016年基层医疗卫生机构卫生资源条件、医疗服务产出总体上呈逐年增加趋势,但在全省中的占比逐年下降。根据计算所得定基比,卫生资源条件中财政补助收入的增长较快（2016年定基比为134.84%）,医疗服务产出中医疗收入的增长较快（2016年定基比为115.58%）。2012-2014年基层医疗卫生机构床位数年增长率为3.74%,2014-2016年增长率下降为1.82%;2012-2014年基层医疗卫生机构医疗收入年增长率为11.38%,2014-2016年增长率下降为7.51%。2012-2016年基层医疗卫生机构医护比为1∶0.54~1∶0.59。2016年基层医疗卫生机构药占比高于2014、2015年,达55.82%。结论　江苏省综合医改试点后,基层医疗卫生机构改革取得了一定成效,但仍有提升空间,应该进一步加大对基层医疗服务能力的提升。     

Rehabilitation services in Papua New Guinea

It is now accepted that in developing countries community-based rehabilitation (CBR) is the most effective way to meet the needs of the disabled. The proportion of the population of Papua New Guinea (PNG) having access to CBR is not known. The purpose of this project was to clarify the extent of rehabilitation services in PNG. It was hoped that by establishing the extent of services, communication and cooperation between them would increase, leading to more efficient and effective use of the limited resources (human and otherwise) available for rehabilitation in PNG. A questionnaire was sent to all known existing rehabilitation services, all provincial health departments, provincial hospitals and church health services. A 47% response rate was achieved. Results showed that most provinces have some form of rehabilitation available but rehabilitation is not spread equally throughout PNG. Most of the services are based in the urban centres and the rural population is badly served except in the Highlands Region and the Sepik provinces, which appear to be more comprehensively served by CBR. The services that do exist are hampered by lack of human and material resources and difficulty accessing clients due to transport difficulties. There needs to be a greater movement of rehabilitation into the community with government backing. The greatest effort is being made by Callan Services for Disabled Persons based in Wewak with its group of Special Education Resource Centres that also carry out CBR. CBR would appear to be an appropriate way to address the needs of the disabled PNG population, but in order to be successful it requires greater backing and more trained personnel.     

Public-private partnerships for health--what does the evidence say?

This paper provides an overview of the literature regarding public-private partnerships (PPPs) by examining several case studies from around the world and documenting the lessons learned across different PPP models. In addition, it focuses on experience in the facilitation of two PPPs between the public and private sectors in Papua New Guinea (PNG) and discusses the potential benefits that may be delivered to PNG communities through pursuing further such PPPs for health.     

Evidence of primary transmission of multidrug-resistant tuberculosis in the Western Province of Papua New Guinea

OBJECTIVE: To review patient outcomes and the molecular epidemiology of multidrug-resistant tuberculosis (MDR-TB) strains isolated from patients living in the Western Province of Papua New Guinea (PNG) seeking treatment in Australia. DESIGN, SETTING AND PARTICIPANTS: Review of all cases of MDR-TB among people living in the open border region between the Western Province of PNG and the Torres Strait Islands of Australia who presented to health clinics in the region between 2000 and 2006. All cases of suspected TB were bacteriologically confirmed at the time of presentation by the Mycobacterium Reference Laboratory in Brisbane. MAIN OUTCOME MEASURES: Drug resistance patterns; drug use and duration; molecular typing of TB strains; patient outcomes. RESULTS: Between 2000 and 2006, 60 patients from the Western Province of PNG were diagnosed with TB, of which 15 had MDR-TB. Mortality was high, although no patient who was able to maintain access to supervised therapy died. All 15 MDR-TB isolates were Beijing-family strains showing the same unique mycobacterial interspersed repetitive unit (MIRU) profile, with the exception of a single strain that differed by a single repeat at one locus. Restriction fragment length polymorphism (RFLP) typing on 10 of these strains further differentiated them into two distinct clusters. CONCLUSION: Transmission of MDR-TB is occurring in the Western Province of PNG. Additional resources are urgently needed to interrupt the ongoing transmission of MDR-TB from the Western Province of PNG to the Torres Strait Islands. Good supervision and management of patient treatment, which includes ensuring a regular supply of second-line anti-TB drugs, are essential elements of TB control.     

我国突发公共卫生事件风险识别、评价和缓解能力的现状

目的了解我国突发公共卫生事件风险识别、评价和缓解能力的现状。方法采用分层抽样随机抽取4个省(市)作为调查样本,采用卫生部统计信息中心编制的《省/地市级突发公共卫生事件应对能力评价问卷》进行调查。结果共发放问卷66份,问卷回收率为90.91%。58%的地市(州)识别了当地可能发生的突发公共卫生事件,28%的地市(州)对所识别的突发公共卫生事件进行了风险评价,8%的地市(州)对当地易发生事故的厂矿企业及大型设施进行了风险评价,10%的地市(州)根据风险评价结果确定了当地突发公共卫生事件工作重点,10%的地市(州)针对主要突发公共卫生事件制定了专门预防策略,5%的地市(州)对当地居民的脆弱性进行了评估,57%的地市(州)开展过或正在开展应对能力评价工作,4省(市)突发公共卫生事件风险识别、评价和缓解能力的平均标准分为24.05,总体均数的95%置信区间为(18.32,29.77)。结论风险识别、评价和缓解工作在我国的突发公共卫生事件管理中重视程度不够,政府应采取措施提高此方面的应对能力。     

Human resource development: new assessments and new directions

The National Health Plan (NHP) 2001-2010 required a health workforce situation analysis and strategy to match the NHP's priorities and strategies. This paper is based on the work that was done in 2001 to support the preparation of a Health Human Resource Development Strategy for Papua New Guinea (PNG). The analysis showed that changes in health sector financing, population growth and changing health needs had created many human resource problems and challenges. This paper focuses on the main categories of health worker in PNG: doctors, health extension officers, nurses and community health workers. It presents analyses of workforce numbers and costs, and discusses future health system and human resource strategies based on the 2001 study and subsequent developments.     

Public health and health reform in Australia

The national health reform agenda appears to have omitted public health. In this article, I outline how public health is different from primary care, and why a holistic approach to reform should include public health. The current reform agenda is very much focused on addressing the problems in acute care and the hospital system, with the focus on primary care being a means to this end. Until the health system is addressed as a whole, with all its essential components integrated and interlinked, truly successful reform of the health system, with genuine long-term vision and sustainability, will not be possible.     

Beyond the numbers: Papua New Guinean perspectives on the major health conditions and programs of the country

How members of the community perceive and respond to diseases and health problems are important variables to take into account when planning interventions and priorities in a health system. This paper summarizes some qualitative research undertaken in 2001 and 2002 in Papua New Guinea as part of the formative research for health promotion activity development for immunization, maternal health, tuberculosis and malaria services. It provides some highlights of the health beliefs and health-seeking behaviours amongst a range of urban and rural populations in a range of provinces in Papua New Guinea (PNG), and across a range of age groups including young adults. The findings reinforce that these health-related issues are seen by most of the population as important, although maternal health lags behind, especially in male respondents' perspectives. However, how they respond varies often with the planned health system interventions, and these differences need to be understood and addressed in order to increase the acceptability and efficiency of health services in PNG.     

Persistence as the path from motivation to performance in the Papua New Guinea health sector

This paper considers how the individual capacity states of motivation, confidence, skill and ability relate to performance, and identifies a crucial role for the discretionary behaviour of individuals: specifically, employee persistence and innovation. The study Understanding the people and performance link: unlocking the black box undertaken by Purcell and colleagues is relied upon in constructing a theoretical framework for the conceptual interrelationships between performance and the human-resource-mediating variables, which is then applied within the Papua New Guinea (PNG) health sector context. The study by Purcell and colleagues, which was informed by organizations with well-developed and functioning human resource policies and practices, is distinguished from the PNG health sector, where human resource frameworks are largely ineffective--yet it is determined that the importance of 'discretionary behaviour' relative to performance, whilst varied, is undiminished.     

我国医疗安全与风险管理的政府职能变化历程

目的:分析我国医疗安全与风险的政府管理职能变化过程。方法:检索CNKI中国学术期刊网络出版总库以及CNKI中国法律知识资源总库相关资料,并对检索结果进行系统性分析。结果:检索文献14134篇,法律法规614部(篇)。结论:建国60多年来,政府在医疗安全与风险管理理念上的变化是"医疗质量管理-医疗质量与安全-医疗质量安全加风险防范"的过程;而在具体措施上经历了"医法独立-医法结合探索-医法结合-全面结合"的过程。     

Health insurance reform: labor versus health perspectives

The Ministry of Labor (MOL) has submitted to the Council of Ministers a social security reform plan. The Ministry of Public Health (MOPH) considers that health financing should be dealt with as part of a more comprehensive health reform plan that falls under its prerogatives. While a virulent political discussion is taking place, major stakeholders' inputs are very limited and civil society is totally put away from the whole policy making process. The role of the media is restricted to reproducing political disputes, without meaningful substantive debate. This paper discusses health insurance reform from labor market as well as public health perspectives, and aims at launching a serious public debate on this crucial issue that touches the life of every citizen.     

Ribotyping of Salmonella enterica serovar Typhi isolates from Papua New Guinea over the period 1977 to 1996

The prevalence of typhoid in the Papua New Guinea (PNG) highlands region increased rapidly in the mid-1980s, and now remains endemic. In this study ribotyping has been used to examine the number and types of Salmonella enterica serovar Typhi strains present during the 1977-1996 period. The ribotyping banding pattern results were based on Cla I and Eco RV digests. The 57 PNG isolates were divided into 11 different ribotypes. Comparison of ribotypes using coefficient of similarity values revealed a diverse group of ribotypes. Several strains appear to be endemic in PNG For instance, ribotypes 1, 2 and 3 were most commonly found among PNG isolates and isolates with these ribotypes have been cultured over a period of at least 11 years (1985-1996). Ribotype 3 was also observed in isolates from Malaysia and Thailand. Also found in PNG were ribotypes 4, 5, 6, 7, 8, 9, 16 and 17. The ribotyping suggests that serovar Typhi strains present in PNG include unique strains of serovar Typhi and also strains that are common to other countries.     

Common themes in the literature on traditional medicine in Papua New Guinea

A review of the literature on traditional medical practices and beliefs in Papua New Guinea (PNG) was conducted in order to provide context and background information for the Department of Health's National Policy on Traditional Medicine for Papua New Guinea. The literature review examined accounts that refer to all 19 provinces and 50 different cultural groups. PNG is renowned for its cultural diversity and it was evident in the literature review that many beliefs and practices are specific to particular cultural groups. Many cultural groups adopt unique practices based on their own specific explanations of illness. At the same time, the review identified a number of commonalities in concepts of health and illness, treatment-seeking behaviour and reactions to the introduction of western medicine among Papua New Guineans from different geographic areas. Both the diversity and the commonalities provide context and background for the National Policy that was approved by the National Executive Committee in March 2007 and officially launched in April 2009. The commonalities are pertinent to the policy on a national level while the diversity must be considered when the policy is implemented at the local level. Summarizing the commonalities between different cultural groups illuminates central belief and behaviour constructs relating to health and illness. Ideas and similarities in practice or perceptions relating to traditional medicine in PNG that are common across a number of provinces are the subject of this paper. The most common features include a belief in the power of sorcery, which is universal, the importance of adherence to customary law and the healing power of herbs and incantation. These findings are a working draft of the expected norms of traditional medicine in PNG, which can be tested and refined during the process of implementing the National Policy, which, it should be noted, explicitly excludes the use of sorcery.