How PPPs are helping Papua New Guinea government deliver better rural primary health services

By Health Team 

Asian Development Bank

Written by Sakiko Tanaka, Senior Economist

The health status of the population of Papua New Guinea (PNG) has deteriorated since the 1980s due to neglect of the health system, especially in rural areas, where 87% of the population live. An estimated 40% of rural health facilities have closed or are not fully functioning. Limited resources, deteriorating infrastructure, poorly trained staff, and inadequate supervision have resulted in declining access to basic health services which together are the main contributing factors in the declining population level health status. As a result, the situation has made health indicators worse, particularly for maternal and child health. The infant mortality rate is 57 per 1,000 live births and the maternal mortality rate is 733 per 100,000 live births (PNG National Department of Health, 2010; PNG National Statistics Office, 2009).  

The ADB grant 0042 HIV/AIDS Prevention and Control in Rural Development Enclaves Project (2006-2012) supported the National Department of Health (DOH) in PNG to successfully build innovative partnerships with non-state service providers to improve rural primary health care service delivery. Under the project, local health authorities in eight provinces established partnerships with six large private companies to improve more than 150 rural health facilities and staff housings, and train health workers and communities in preventing HIV transmission, thereby significantly increasing the number of primary health beneficiaries in project areas.

The project aimed to strengthen the government leadership and the implementation of strategies to contain the spread of HIV among rural populations. It had four components: 

1. Public-private partnerships with rural development enclaves; 
2. Social marketing of condoms and community behavior change communication interventions; 
3. Strengthening the STI and HIV/AIDS surveillance system; and 
4. Project management and coordination

Before the renovations of Kawi Aid Post in Western Highlands province

Component 1 supported the establishment of public-private partnerships (PPP) with rural development operators such as oil, mine and agricultural companies to focus on improving and extending health services to the surrounding communities. Six private companies signed Memoranda of Agreements with the DOH and provincial stakeholders in 2007.  Under the partnerships, 154 health facilities including 97 health facilities and 57 staff houses were renovated. Of these 97 health facilities, 50% are managed by the government, 25% are company facilities, and 25% are church managed facilities. Medical equipment was also provided to all health facilities. Health human resources were strengthened through training programs such as HIV Testing and Counseling and the management of Sexually Transmitted Infections (STI).  

Private partners provided their support for supervisions of facility renovations including ensuring safe water supply with water tanks, distributions of new equipment and condoms, and organizations of workshops and trainings. Some companies hired a group of health experts to specifically implement the project as well as to strengthen health services in their catchment areas. The project triggered the companies’ managers to realize the importance of the support to the local communities on improving rural health services delivery. One of the companies successfully established a health foundation to strengthen their support in primary health care not only in their catchment areas but also in other provinces in PNG. The government officials were also realized the great potential and possibility of improving health outcomes of the people by strengthening the partnerships with non-state providers. 

Post renovations

As a result, the project contributed to increase the number of people tested for HIV at enclave health facilities by 65% between 2005 and 2010 (a total of 56,056 HIV tests were recorded here by the end of 2010). Although the project was started with a scope of HIV prevention and care, it also contributed to increase in the number of women attending for at least one antenatal visit with the target of 10% increase being reached in 2009. There was also an improvement in the number of supervised births in health facilities by 10% from 2007. 

Building the PPP model initiated by the enclave project, the new rural primary health services project in PNG will further examine the model in 16 districts in 8 provinces in PNG. The project has just started in June 2012 and looks forward the new PPP opportunities in each province to strengthening rural primary services delivery.