AUTONOMOUS BOUGAINVILLE GOVERNMENT
2012 to 2030
Draft 28 April 2012. This draft has been prepared based on the deliberations of a technical working group of senior Bougainville health personnel and discussions with stakeholders in the ABG health system.

Contents
Message from the Vice President.......................................................................................... 2
Overview ............................................................................................................................... 3
Priorities ................................................................................................................................ 5
Demography ......................................................................................................................... 6
Health trends ........................................................................................................................ 7
Strategies .............................................................................................................................. 9
Health sector human and financial resources ...................................................................... 10
Timeline .............................................................................................................................. 15
Risks ................................................................................................................................... 19
Governance and management ............................................................................................ 19
Next steps ........................................................................................................................... 20
Appendix 1: Values that underpin the work of the ARB health sector .................................. 21
Appendix 2: Accountability and teamwork statement by health sector leaders .................... 22
Appendix 3: Strategies in detail ........................................................................................... 23
Appendix 4: Performance and trends .................................................................................. 35
Appendix 5: Measuring Progress ........................................................................................ 42
Appendix 6: Linkages between relevant global, national and ARB planning documents ...... 43
Appendix 7: Indicators and targets from planning documents ............................................. 45
Appendix 8: Traditional medicine in Bougainville ................................................................. 46
Appendix 9: Cost and financing scenarios ........................................................................... 48
Appendix 10: Draft timetable of significant events ............................................................... 64
Appendix 11: Prioritisation and sequencing ......................................................................... 67
Appendix 12: Technical advisory group for this plan........................................................... 68
1

Too be completed once the VP has reviewed the document.
2

This is the plan for health in Bougainville for the next 18 years. It will guide our health services through a period of rapid change; political, economic, environmental and social.
This plan aims for all People of Bougainville to live a long and healthy life. Mamong for
Health expresses the concept of women being central to achieving improvements in health.
(‘ Mamong ’ means females of all ages in the language of the Tinputz District). ‘Women at the centre of health development’ is part of ARB’s vision for health and a key factor in improving the health of the whole population. The role of women, as both the main users of health services and providers of care within families, is recognized and valued. Empowering women and improving health literacy among women will enable them to care for both themselves and others and will lead to better health for all; men, women and children.
In this plan we commit to important goals in the short term – the reduction in deaths of women in childbirth, the rebuilding of our rural health and hospital buildings, the development of our health workforce. In the longer term we intend to tackle the health needs of our children, and drive out the scourge of preventable diseases and malaria. We will also reconnect with the old ways in the effective use of herbal medicines.
We also need to prepare to meet new challenges. We will face some as yet unknown diseases, while some conditions will become more important. For example, non communicable diseases. These are a consequence of increased use and misuse of alcohol and tobacco coupled with the worse aspects of the modern diet that has too much fat, sugar and salt. The response to these needs to involve other sectors, working across different parts of government to achieve a healthier society.
To drive this plan forward we will create the Bougainville Health Authority that will combine the current Health Division and the Buka Hospital services. This authority will work in close partnership with the churches, the NGOs, and the private sector in the provision of services.
Executing this plan will face a number of challenges. We will meet these though the continued commitment of the health workforce, and the ongoing support of our donor partners and the GoPNG.
In the following diagram, we show the vision is empowered by the Upe, from our flag and our constitution. The strategies are displayed on the Biruka, the protective and cooling fan women use. The strategies are driven by the commitment of the sector to core values of
Accountability, Teamwork, People focus, Equity and Quality.
3

4

These are the four priorities for the next three years.
Consistent with our commitment to putting women at the centre, the first priority we have is to improve maternal health for the women of Bougainville. We are already close to achieving the expectations of the Millennium Development Goal to reduce maternal mortality. With a committed effort from the sector we will achieve this goal. Success in this area will help build the momentum for health so that we can tackle other goals in this plan.
The Autonomous Region of Bougainville (ARB) health care infrastructure was partially destroyed during the crisis, and it is our intention to bring it back to strength. Beginning with the rural infrastructure, we will progressively rebuild our health facilities, so that all our population has access to quality health services. This rebuild will first focus on rural health facilities, followed by a CHW training schools, then hospital facilities in Central and South region.
The workforce is the fundamental building block for improved health delivery. This plan makes a priority of increased training and development support for the current workforce, as well as developing the workforce for the future.
These three priorities cannot wait for the ideal structures to be put in place. Taskforces will be formed to progress these issues, led by senior people from the sector. These taskforces will be made up from the different parts of the sector – not just government. The focus will be on achieving the required results within a specified budget and timeline.
This will combine the Buka Hospital and the rural health services into a single organisation. It will make all the health service directly accountable to the ABG. It will also enable better use of scarce existing capacity (eg in HR, medical officers, training) across the Autonomous
Bougainville Government (ABG) health system rather than being confined to a particular institution.
5

400000
350000
300000
250000
200000
150000
100000
50000
0
The population in Bougainville has grown by 2.6% per cent a year for the last decade. This means that between 2000 and 2010 the population increased by 60,000. Even if this trend is partially arrested, we can expect the population to reach 350,000 by 2030. Population growth depends on fertility, mortality and migration. Improved family planning reduces fertility and population growth. Infant survival decreases mortality while an ageing population and
NCDs increase mortality. Migration is likely to increasin gly play a role in ARB’s population, and depends on economic and security conditions in ARB and surrounding areas that are accessible to the Bougainville people. In the table below, we have assumed the rate of growth will slow to 2.3% (the current average for the Islands region) until 2020, then to 2.0% for the period 2020 to 2030.
Census
Predicted
1980 1990 2000 2011 2020 2030
6

This plan for health will focus on three long term outcomes:

Maternal health

Infant and child health

A long and healthy life for all Bougainvilleans.
The National Department of Health indicators show ARB as the sixth-best performing province in PNG, although ARB’s performance dropped in 2010. The performance for 2011, however, shows there are distinct improvements in ARB’s indicators over the last year. The
North Region has a higher level of performance on most indicators than the South and
Central. This is a major focus of this plan – making a priority of improving service provision in the Central and South Region, while maintaining improvements in the North.
This plan needs to lift the performance of ARB, by more closely focusing on performance at all levels and facilities. In many instances the knowledge on how to improve performance already exists within ARB. The information from high-performers can be used by other health facilities, districts and regions to lift their performance.
Take, for instance, births in health facilities:
Percentage of births in health facilities: 2006-2011
100%
80%
60%
40%
20%
0%
NATIONAL
KIETA - CENTRAL
BUKA - NORTH
BUIN - SOUTH
ARB
2006 2007 2008 2009 2010 2011
The health plan intends to train health workers undertaking deliveries and to develop the
Arawa and Buin hospitals. This should result in an increase in births in facilities in Central and South, reduced travelling times for obstetric emergencies and fewer maternal deaths.
7

The result these developments will aim for is that 80% of women in all three regions will give birth in health facilities under a health worker with training in obstetric care.
Another part of reducing maternal mortality is family planning. Over the last three years, the
North Region has made a dramatic improvement in its family planning services.
Couple years protection / 1000 WRA, 2006-2010
200
150
100
NATIONAL
KIETA - CENTRAL
BUKA - NORTH
BUIN - SOUTH
ARB
50
0
2006 2007 2008 2009 2010 2011
From 2008 till the present they have provided one fifth of women of reproductive age with contraception. This has resulted in fewer maternal deaths, fewer deliveries and improved child health. The challenge is for this success to be sustained, and for the Central and South
Region to achieve the same level of performance. If that happens, the predictions of population growth in this plan would need to be revised downwards and many of the goals will be achieved earlier.
The strategies outlined in this plan need to be continuously linked to improved performance against the health indicators. For example, if a facility is improved, or a training course is conducted, these developments should demonstrate improved performance. The appendixes discuss the current performance of health facilities across a range of indicators.
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Good health
Long life
Women at centre
Strengthen health systems and governance
• Improve financial resources and management
• Medical supply
• Information and ICT
• Independent planning and monitoring mechanism
Strengthen partnership and coordination
• Collaborate with partners.
• Negotiate health improvements with extractive industries
Improve service delivery
• Increase access to quality health services
• Strengthen the infrastructure
• Health workforce strengthening
• Access to traditional herbal medicine
Improve child survival
• Immunisation coverage
• IMCI
• Reduce deaths of neonates
• Reduce malnutrition
Improve maternal health
• Family planning
• Safe supervised deliveries
• Improved emergency obstrtetric care
• Sexual and reproductive health
Reduce communicable diseases
• Malaria and TB control
• STI and HIV prevention, care and treatment
• Increase monitoring and surveillance
Prepare for disease outbreaks and new population health issues
• Identify, monitor and report on urgent and emerging threats
• Establish a public health laboratory function
• Addresss the needs of climate change refugees
• Respond to the health challenges of resource extraction
Healthier lifestyles
• Improved prevention and treatment of injuries
• Reduce food and water borne diseases
• Improve housing
• Reduce NCD deaths and illness
Autonomous
Bougainville health system
• Draw down powers
• Develop a Bougainville Health Authority
• Implement the Bougainville Plan for Health
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Health services primarily rely on skilled health workers. Health system performance depends to a large extent on the skills, training and commitment of the health workforce and their accessibility by the population.
The current ARB health workforce has approximately 520 people, divided between the ABG rural health sector (190) the churches (170) and Buka Hospital (117).
The geographic distribution of skilled health workers is uneven, largely concentrated on the
North Region because that is where Buka Hospital is.
Buka General Hospital staff by cadres, 2012
Corporate Services and CEO
Nursing Services
Medical Services
0 20 40 60 80 100
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The rural health workforce however is well distributed.
The regional distribution of rural health workforce by cadres, 2011 1
120
100
HW/Population Ratio
(2008)
80
60
North 828
Central 861
South 680
40
South
Central
North
20
0
CHWs N/O HEO M/Os EHOs
Source: ABG. Building on the Bougainville Strategic Implementation Plan 2011
To meet the requirements of this plan, the health workforce needs to:

increase to keep up with population growth

replace itself as workers retire

increase the skill level of both the current and future health workers.

Increase in the central and south regions
Retraining the large group of workers who had restricted opportunity due to the crisis is an early priority. In addition, the plan intends to make the most skilled workers, (doctors, midwives, nurses) more accessible to the rural population, particularly in the Central and
South Region.
As a consequence of the crisis, the health worker training institutions have been lost. The priority is to re-establish the community health worker (CHW) training school, at the same time work with existing PNG training institutions to ensure future workforce requirements are met.
1 These figures need to be updated with 2011 census figures.
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A taskforce made up of Buka Hospital, the Rural Health Division and the churches will lead the development of this area to meet the plan’s requirements. The work of the taskforce includes:

Overcoming immediate under-staffing and up skilling problems through undertaking a training needs assessment and up-skilling crisis trained workers and up-skilling all workers involved in maternity care.

Establishing a sustainable pipeline of skilled health workers (HW) for the future by working with PNG training providers, seeking scholarships, and securing placements with existing providers for ARB trainees.

Developing ARB ’s own training capacity for CHWs and nursing officers and midwives, beginning with a CHW training school.

Increasing the productivity of current health workforce by measuring and discussing each facility’s performance, increasing supervision, developing incentives and performance appraisals.

Establishing a cross-organisational health human resources (HR) information system.
Currently most of the money coming into the ARB health sector comes from the government of PNG (GoPNG), with smaller contributions by donors and the ABG government (see table below). The level of spending is about the bare minimum required to effectively run a health service, and well below what neighbouring countries are spending on health.
30 100%
25
77.28%
20
Expenditure
2012 Kina (Mill)
15
10
17.80%
5
4.92%
0
ABG Donors GoPNG Total
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This plan assumes that by 2030 ARB health spending will reach the current average expenditure on health for Melanesia, which is double the current ARB expenditure, or an annual real increase of 6%.
Melanesian comparisons – per capita government health expenditure US$ 2
160
140
120
Per capita
Expenditure
US$
100
80
60
40
20
0
35
58,59
100
108
131
PNG ABG Solomons Fiji
143
Kiribati Vanuatu
If expenditure only just keeps up with inflation (6.1%) and population growth (2.3%) then it will be impossible to staff and run the additional services and facilities outlined in this plan.
Resources would have to be taken from an existing part of the health sector.
The big challenge in financing this plan will come between 2015 and 2020 as a consequence of changes made as a result of the referendum. If the referendum decision leads to financial independence from PNG, then there is likely to be a lag period before ABG is able to generate enough of its own revenue to replace the current GoPNG contribution to health.
2 National Health Expenditure Indicators WHO 2010. Note: General government health expenditures, as given by WHO, include capital expenditures and are collected from national health accounts, when available, and other government sources. Refer to WHO website: http://www.who.int/healthinfo/statistics/indhealthexpenditure/en/index.html
Accessed 30 April 2012.
13

Bringing ABG health expenditure up to US$120 per capita by 2030 on a steady basis with a 5.92% real increase per year (before inflation)
US$120 per capita by
100
2030
Likely Funding Gap
80 period
Total Government
Sourced
Expenditure 2012
Kina (Millions)
60
40
US$100 per capita by
ABG
GoPNG
Total
20 2025
0
The financing of this plan requires a commitment by all partners: the government of PNG,
ABG, donor partners and development banks to a funding pathway as indicated above.
In addition, the different funding mechanisms need to be brought together so that the
Bougainville health system can make optimal and efficient use of the funds. There is not the management capacity to deal with multiple funders and multiple accountability and reporting lines.
14

2015
ARB achieves MDG 5?
2013
ARB achieves 95%
Immunisation coverage
2017
ARB achieves Universal Coverage ?
2014
Population growth slows to
Xxxx births per year
2020
ARB achieves MDG4 ?
Health Goals
2030
ARB Eliminates Malaria
Life expectancy 75
2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
2012
2012
STI clinics Arawa and Buin
2014
Access to free care
And full immunisation through DHFF rollout.
2015
Rural Health
Infrastructure
rejuvenated
2019
Arawa Hospital re-built
2019
Rural Hospital development (2)
2023
Nursing school established
Building Blocks
2027
Provincial Hospital Upgade
2030
2018
CHW training school completed
5/1/2012
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The changing shape of the ARB health sector
2012 2030
Referrals to other hospitals
Referrals to other hospitals reduced
Buka (District)
Hospital
Health centres and sub health centres
Buka Hospital — enhanced specialist capacity
Aid posts
Arawa, Buin, Tanamalo, Moratona
District and Rural Hospitals
Health centres and community health posts accessible to all
BHCP in 300 villages
BHCP in all villages. Herbal medicines integrated
The crisis has left the ARB health sector with a depleted healthcare infrastructure, as a consequence of the destruction of key facilities such as Arawa Hospital. A key focus of the plan is to rebuild this infrastructure over the next 10 years.
This rebuilding will take a different shape to the current health infrastructure. Changes in communication and transport systems, including roads and bridges, make a big difference to the way people use health services. The redevelopment of the roading system will mean people travel to health facilities more easily. This means there will be a need for fewer facilities, but they will have far greater capacity.
In addition, what is being expected of a health facility has changed. In order to meet the aspirations of this plan, health facilities need to be offering a higher level of skill and a wider range of services than is seen currently. The future will see fewer aid posts, and the development of community health posts with a minimum of three staff. There will be fewer in-
16

patient facilities in health centres and community health posts – most people requiring more than a short stay as an inpatient will travel to the hospitals.
Effective transport arrangements between the facilities will be an important part of the health system.
The plan has indicated a number of buildings that are required for the ABG health sector.
The timing of the building developments depends on the availability of financial and staff resources to sustain a facility once it is built.
As the table below indicates, some of these are already planned and funded – others will require further development of a business case to resolve issues of location, size, cost and staffing.
17

ARB health infrastructure plan
Facility
STI Clinics (2)
Rural health service delivery
& rural health infrastructure upgrade
Rural health service delivery
& rural health infrastructure upgrade
CHW training school establishment
Arawa District
Hospital development
Rural hospital development
Tanamalo,
Moratona
Buin Hospital development
Start
2012
Finish
2012
Comments Capital cost Additional staff
At Buin and Arawa AusAID project funded and currently underway
Recurrent costs.
2012
?2013 ?2016
?2018 ?2020
?2020 ?2019
?2016 ?2021
2022
2016?
2022-
2029
Covers South and
Central Region
North
Increased availability of
CHWs
New/rebuilt district hospital
Currently MSF supporting this service at K2.2m per year till 2016
ADB/AusAID/ and other donors. K20m over 5 years
No funding identified
K 10m
K25m
K20m
?K10m
K120m
? 20
? 10
60
?20
?15
?
?K1m
? K0.5m
Currently met by
GoPNG
?K5m
? K2m
?2.2m
? K20m Development of Buka
Hospital as provincial hospital
Nursing school development
Children’s hospital development
2023? 2030
Post
2030
A full list of sector developments is in Appendix 10.
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The Health Plan identifies the risks inherent in health development and also the mitigating factors.
Risk Mitigation
Financial resources for health well below predictions
Financial resources to ARB government well below that required to sustain health services
Seek agreement on Financial envelope from
GoPNG, ABG, Donors prior to committing to plan.
Reduce scope of plan to fit available resources.
Continued instability, restricting access to parts of
ARB, staff insecure.
Instability in PNG government and interruption of resource flows
Decentralise (DHFF) to support local level activity even when access is difficult.
Work with Donors to achieve uninterrupted funding flows. Ensure neutrality of facilities and personnel.
Change in donor policies reducing donor support
Implementation failure of major priorities
Increase rate of ABG financial self reliance.
Trained Health workers migrate to other countries. Introduce package of measure to make ARB attractive for Health workers.
Establishing a project management function to drive priorities.
The plan is to develop a single ABG health organisation, the Bougainville Health Authority.
This will have a board, and be solely answerable to the ABG through the Minister of Health
(unlike provincial health authorities in other provinces who are answerable to both the
Minister of Health of GoPNG and the Governor ).
In order to kick-start the priorities in this plan, three cross-sectoral taskforces will be formed.
They will form part of the executive team of the Division of Health, and their work will be facilitated by project management and accountancy support.
It is envisaged that these task forces will be in place for a limited time of 3 -4 years. They would be resourced to get the job done and make sure the services are able to sustain the work once each taskforce finishes.
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1. The draft plan is reviewed and adjusted by ABG.
2. The plan is finalised and endorsed by ABG.
3. The accountability and teamwork statement formally ratified by the health sector leaders.
4. ABG commits to support the plan with 15% of ABG revenue and GoPNG development grant till 2016.
5. The ABG plan for 6% real growth (after inflation adjustments) per annum in financing
2015 to 2030.
6. The plan is presented to a donor summit and support sought from donors in three areas:

Commitment to extend existing donor support levels to complete rebuilding of the health infrastructure

Assistance with bridging finance 2015-2020 in the event of post referendum financial separation from the GoPNG.

Donor coordination and resource pooling to reduce complexity and align donor support with the plan.
7. Establishment of Independent advisory group reporting to the Minister of Health to monitor the roll out of the plan.
8. Establishment of three cross-sectoral taskforces (Maternal health, Facilities, Health human resources).
9. Establishment of the Bougainville Health Authority
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Accountability – The health sector and service providers are accountable to both the
Minister of Health and the communities they serve. Staff shall demonstrate commitment to the highest ethical standards in all aspects of their work. There should be transparency in the use of funds and allocation of resources for health.
This plan includes an accountability statement. The leaders of the PNG health sector commit to this statement and will be held accountable for the sector’s performance.
People focus – Health services will be people-focused, empowering individuals to take ownership for their own health and to become self-reliant. Health literacy will be promoted at every opportunity and for all ages. Decisions taken in the health sector will have a peoplefocus at their core and will determine how proposals impact on the health of the people.
Quality – Health services will meet standards and will have skilled professional staff, adequate medical supplies and equipment appropriate for the level of care provided. The health sector will strive for excellence, reflect on past performance and apply the wisdom gained to continuously improve.
Teamwork – Within the health sector and between the health sector and other sectors, partnerships, networking and teamwork will be promoted to achieve coordinated and cohesive delivery of services. Teamwork applies across different parts of the sector
(community, primary, secondary, tertiary, public health) and across different health organizations (hospital, rural health, churches etc.).
Equity
– Health is a basic human right that is fundamental to quality of life and a core commitment made in the ARB constitution: “ to govern through democracy, accountability,
equality and social justice
”.
All Bougainvilleans have an equal right to quality health care. This means the health sector will strive to address inequities of health outcomes and service provision, such as the current under-provision of services for the Central and South Regions.
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This statement has been crafted and agreed by the technical group who developed the ARB
Plan for Health.
We will focus on results now and avoid excuses
We will be measured by what we deliver and the way it benefits the people of ARB.
Performance will be measured quarterly by the Minister. We accept and expect both rewards and sanctions based on our performance against recognised indicators and benchmarks.
Teamwork strong cross-government and cross agency collaboration
Our priorities, the delivery of ARB plan for Health, require contributions from across government (GoPNG, Buka Hospital, and Rural Health Division) and across partners, including church, donor and private.
We will work based on our contribution to these priorities, not our institutional boundaries, and push each other to speed up delivery.
We will form and resource time-limited cross-organisational teams when the task requires it and take responsibility for the whole team’s performance.
Improved communication
Successful communication is critical to our success. Responsibility for proactive communication, sharing information and strengthening working synergies will be part of our working culture.
A proactive approach
We are all responsible for identifying solutions, not waiting for others to provide them. We will improve both our planning processes and implementation.
We will commit annually to a level of service improvement in any given year for each region and accept independent assessment of the effectiveness of our performance and the reasons for good and poor performance. Independent assessment will include a process where communities evaluate our performance.
We will also accept rewards and sanctions based on this performance assessment.
Signed:
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(See ABG ’s Medium Term Development Plan (MTDP) 2011-2015, page 131)
There are nine strategies to achieve the goal of better management, effective programs and healthier communities. They are set out in detail below.
No. Sector Strategy 3
1 Improve service delivery
2 Strengthen partnership and coordination with stakeholders
3 Strengthen health systems and governance
4 Improve child survival
5 Improve maternal health
6 Reduce the burden of communicable diseases
7 Promote healthier lifestyles
8 Improve preparedness for disease outbreaks and emerging population health issues
9 The ABG and GoPNG work together to promote a solid basis for an Autonomous
Bougainville health system
3 ABG ’s MTDP 2011-2015, page 131
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Sector strategy 1: Improve service delivery
Objectives
1.1 Increase access to quality health services for the rural majority.
1.2
1.3
Rehabilitate and strengthen PHC and hospital infrastructure and equipment.
The right health professionals work in the right places, are motivated, and deliver right (quality) services.
Strategies
1.1.1
Expand BHCP into all districts and introduce village health treasury concept as a way of empowering communities to address sustainability of Bougainville healthy community program.
1.1.2
Conduct integrated outreach to ensure 95% population coverage for Maternal Child Health and disease control.
1.1.3
Remove user fees and decentralize funding through
Direct Facilities Funding for operational activities at all health centres (HCs), health subcentres (HSCs) and community health posts (CHPs).
1.1.4
Provide 24 hour access to transport from all HCs to hospitals for emergencies.
1.2.1 Rationalize best locations and type of health facilities based on an assessment of the population served and travel time.
1.2.2 Rehabilitate or establish rural health infrastructure
 including:
CHPs and HCs resourced to deliver maternal and child
 health services health promotion activities for populations over 3,000 people.
1.2.3 Rehabilitate essential equipment (furniture, medical equipment, non-medical equipment, refrigeration, static plant, power and water supply, communications) at HCs, rural, district and referral hospitals. All equipement should meet PNG health standards.
1.2.4 Establish district hospitals in Arawa and Buin.
1.2.5 Establish regional hospitals resourced to provide quality health care.
1.2.6 Establish a major referral hospital for Bougainville.
1.3.1 Develop a human resource implementation plan for ABG.
Focus the plan on increasing the numbers of doctors, nurses, midwives, community health workers, allied health workers and health managers and a human resource information system (HRIS).
1.3.2 Determine the distribution and activity levels of the current workforce. Prioritize to place the right people with right skills to provide the most effective delivery of health services for Bougainville as a whole.
1.3.3 Develop training needs assessment and deliver training for current and future HHR including developing CHW and NO training schools.
1.3.4 Ensure regular clinical and management supervision by personnel trained in supervision to HCs, HSCs and CHPs, based on checklists and health standards.
1.3.5 Increase staff ceilings for critical health workers and
24

Objectives Strategies
1.4 Promote easy access to safe and effective forms of traditional medicine and practices as part of the ARB health system. progressively place medical doctors and visiting specialists in district hospitals and high volume HCs.
1.3.6 Develop and implement affordable health sector workforce recruitment, retention and incentive strategies.
1.4.1 Compile and keep updated an inventory of safe and effective herbal medicines used in Bougainville. Publish the inventory as a booklet.
1.4.2 Develop a quality assurance system for herbal medicines and practitioners.
1.4.3 Develop techniques for the production and preservation of herbal medicines.
1.4.4 Train traditional medical practitioners (TMPs) and traditional birth attendants (TBAs) in primary health care.
1.4.5 Encourage collaboration between primary health care providers and TMPs and the sharing of knowledge. Trial the sharing of premises (aid posts) and the development of medicinal herb gardens at HCs and primary schools.
1.4.6 Strengthen the Bougainville Traditional Healers’
Association (BouTHA) through management support and training.
Performance indicator
No 21 Outpatient visits per person per year
25

Sector strategy 2: Strengthen partnership and coordination with stakeholders
Objectives
2.1 The health sector works collaboratively with all stakeholders to expand the reach of quality health services.
2.2 Implement ABG public private partnerships policy and introduce innovative and cost effective options for delivering services.
Objectives
2.1.1
Develop the Bougainville Health Board to coordinate health development.
2.1.2
Establish and strengthen the Bougainville Churches
Medical Council.
2.1.3
Engage community-based organizations in planning, delivering and evaluating health services.
2.1.4
Merge BHCP into the mainstream health system.
2.1.5
Enhance communication, cooperation, reporting and coordination with central agencies and other
Bougainville sectoral departments, especially with the
Departments of Treasury, Planning, Finance and
Provincial and Local Level Government.
2.2.1 Enter into agreements with extractive industries to reduce health impact and agree mitigation measures before mining operations begin.
2.2.2 Include private health providers in the health sector coordinating body.
26

Sector strategy 3: Strengthen health systems and governance
Objectives
3.1 Improve financial resourcing and management for health service delivery.
3.2 Medical supply procurement and distribution services are efficient and
3.3 accountable.
The health sector proactively identifies and uses innovative and evolving ICT solutions and delivers accurate and timely information for planning and decision making.
3.4 The Minister for Health is supported by an external advisory group which monitors the implementation of the
Bougainville Health Plan.
Strategies
3.1.1
Develop and agree a funding envelope to 2020 with
GoPNG, ABG, donors. Integrate income streams into single health funding facility. Construct ABG health accounts.
3.2.1 Assess the feasibility of ABG procuring its own medical supplies and the delegation of Pharmaceutical Board responsibilities.
3.2.2 Develop a ‘Pull’ system for medical supplies management for all HCs, HSCs, CHPs.
3.2.3 Merge hospital and rural health services medical supplies systems.
3.3.1 Develop a timely, autonomous and flexible health sector management information system across all layers and institutions of the ARB health system linked to a national patient master index.
3.3.2 Build the capacity of ABG health information officers and hospital medical records officers to compile, analyse, and provide quality information for district and hospital management.
3.3.3 Increase the use of mobile phones for data collection and transfer.
3.3.4 Ensure all health sector providers including the private sector support ARB and national health surveillance systems.
3.4.1 Ensure all stakeholders receiving Government of Papua
New Guinea, health development partner or ABG funding are guided by the Bougainville Health Plan and comply with relevant legislation. Ensure stakeholders provide an audited annual report, including proposed future programming and expenditure.
3.4.2 The Minister of Health holds the CEO Health accountable for the delivery of services in accordance with relevant legislation and the Bougainville Health Plan.
3.4.3 Strengthen the performance monitoring and evaluation framework, by linking information about and reporting on performance, HR and financial resources.
3.4.4 Planning, budgets, expenditure and management decisions are linked to health priorities and evidencebased. Business cases are prepared for all projects exceeding PNGK1 million.
3.4.5 Ensure committees such as the Bougainville Health
Board, Audit Committee, Professional and
Pharmaceutical Board (if devolved) implement quality assurance programs and meet reporting requirements in compliance with legislation.
27

Sector strategy 4: Improve child survival
Objectives Strategies
4.1 Increase coverage of childhood immunization in Bougainville.
4.2 Reduce case fatality rates for pneumonia in children by speeding up the roll out of integrated management of childhood illnesses
(IMCI) to Bougainville.
4.3 Decrease neonatal deaths.
4.1.1
4.2.1
4.2.2
4.2.3
Ensure every facility, every day, at every encounter immunizes children when indicated.
Build the capacity and capability of all HCs and CHPs to implement IMCI.
Increase the percentage of communities with the capacity to implement IMCI in conjunction with BCHP.
Introduce cost effective vaccines, such as pneumococcal vaccine.
4.4 Reduce malnutrition
(moderate to high) in children under the age of five years.
4.3.1 Ensure all HCs and CHPs have the capacity to provide lifesaving support to the neonate.
4.3.2 Ensure 99% coverage of tetanus toxoid for antenatal mothers.
4.4.1 Adopt the ‘First 1000 Days’ strategy.
4.4.2 Support the continuation of exclusive breastfeeding.
4.4.3 Ensure all babies and children under five have access to supplementary feeding when and where they require it.
4.4.4 Increase access for mothers and children to micronutrient supplementation.
Performance indicators
No2 Childhood malnutrition
No9a Measles immunization coverage for children under 1 year
No 9b Third dose TA/pentavalent coverage
28

Sector strategy 5: Improve maternal health
Objectives Strategies
5.1 Increase family planning coverage.
5.2 Increase the capacity of the health sector to provide safe and supervised deliveries.
5.1.1 Ensure every health facility has the capacity to offer family planning services at all times.
5.1.2 Advocate for the advantages of having fewer children and increased spacing of children.
5.2.1 Increase the number of facilities capable of providing supervised deliveries.
5.2.2 Increase the numbers of health workers skilled in obstetric care.
5.3 Improve access to emergency obstetric care (EOC).
5.2.3 Ensure every maternal death (in health facility and in community) is reported, investigated and audited.
Ensure that practices improve as a result. Report maternal deaths to the Minister of Health on a monthly basis.
5.3.1 Increase the capacity of all HCs and CHPs to provide essential EOC.
5.3.2 Ensure all high-volume facilities are capable of providing comprehensive obstetric care.
5.4.1 Increase the knowledge of adolescents about sexual and reproductive health.
5.4 Improve sexual and reproductive health for adolescents. 5.4.2 Increase cross-sectoral collaboration with schools to strengthen education of students in sexual and reproductive health.
Performance indicators
No 10A Proportion of supervised births at health facilities
No 11 Antenatal coverage
No 12 Family planning use
29

Sector strategy 6: Reduce the burden of communicable diseases
Objectives Strategies
6.1 Reduce malaria-related morbidity and mortality in Bougainville.
6.1.1 Galvanize political commitment for malaria control through setting a goal and an implementation plan for malaria elimination.
6.1.2 Provide households with long-lasting insecticide-treated nets (LLIN) to cover all usual sleeping places, and reintroduce residual spraying where appropriate.
6.1.3 Maximize access to prompt quality diagnosis and appropriate treatment for malaria.
6.2 Control tuberculosis (TB) incidence by 2020, with a decline in cases of multi-drug-resistant tuberculosis (MDR-TB).
6.3 Scale up prevention, treatment, care and, support for sexually transmitted infections
(STIs) and HIV to meet universal access targets.
6.2.1 Ensure all TB cases have access to tuberculosis directly observed treatment, short-course (TB DOTS).
6.2.2 Provide HIV counseling and testing for all TB cases.
6.2.3 Strengthen, integrate and implement TB and HIV collaboration.
6.2.4 Work with ABG to develop an intersectoral approach to
6.3.1
6.3.2 improving the indoor environment of domestic dwellings.
Increase access to quality HIV counseling and testing services including prevention of parent-to-child transmission (PPTCT) counseling.
Increase access to quality antiretroviral (ARV) treatment
6.4 Strengthen communicable disease surveillance and monitoring. for adults and children.
6.3.3 Ensure male and female condoms (and lubricants) are available and accessible throughout Bougainville.
6.3.4 Increase access to post-exposure prophylaxis (PEP) services.
6.3.5 Strengthen syndromic management of STIs.
6.3.6 Increase the knowledge of adolescents about sexual and
6.4.1 reproductive health.
Introduce an integrated surveillance and monitoring strategy for cholera, emerging diseases, neglected tropical diseases, hookworm, leprosy and other infectious diseases.
6.4.2 Strengthen epidemic surveillance and response capacity for communicable diseases with a potential for outbreaks.
Performance indicator
No 4 Malaria incidence per 1000 population
30

Sector strategy 7: Promote healthy lifestyles
Objectives
7.1 Increase health sector
7.2 response to the prevention of injuries, trauma, and violence.
Reduce the number of outbreaks of food and water-borne diseases.
7.3 Reduce morbidity and mortality from noncommunicable diseases.
Strategies
7.1.1 Increase population-based programs designed to reduce the number of preventable injuries and trauma.
7.1.2 Increase the roll out of and access to family support centres.
7.1.3 Increase and build adequate capacity of hospital accident and emergency departments to address transportrelated injuries. This applies to the existing and two proposed hospitals as well as the proposed new referral hospital.
7.2.1 Establish water management committees to manage and control rural water supplies and sanitation.
7.2.2 Increase the number of households that have access to safe drinking water, and effective waste disposal and sanitation.
7.2.3 Ensure all health facilities have access to running water, and effective waste disposal and sanitation.
7.2.4 Ensure public and private buildings comply with legislation in relation to water supply, sanitation, and food handling.
7.2.5 Review and improve relevant legislation to enhance the management and control of rural water supplies.
7.3.1 Increase the focus on population-based health interventions designed to reduce the impact of substance abuse and excessive alcohol use, including home brew. Promote increased levels of physical activity and improved diet.
7.3.2 Implement population-wide early detection (screening) and immediate clinical interventions for noncommunicable diseases, such as heart disease, strokes, diabetes, and cancers with an initial focus on cervical cancer.
7.3.3 Support employers in ARB to promote healthy diet, opportunities for regular physical activity and smoke-free working environments.
7.3.4 Review and improve legislation that will support tobacco control, and reduce the sales and marketing of drinks and foods high in fat, salt and sugar.
7.3.5 Improve and expand mental health services to address a range of mental health issues, including post-traumatic stress disorder.
7.3.6 Improve disability and community-based rehabilitation services.
7.3.7 Ensure all public and private sector employees routinely undergo medical examinations for the early detection of lifestyle diseases.
31

Objectives Strategies
Performance indicator
No 6 Diarrhoeal disease in children less than 5 years
No 7 Injuries reported at outpatients per 100 population
32

Sector strategy 8: Improve preparedness for disease outbreaks and emerging population health issues
Objectives
8.1 Increase capacity of the health sector to identify, monitor, report on and respond to urgent and emerging health threats.
8.2 Establish Bougainville
Public Health Laboratory
(BPHL) function to provide services to meet urgent and emerging concerns.
8.3 Improve capacity and preparedness of the health sector to address the impacts of climate change.
8.4 Ensure the health sector works collaboratively to manage population health threats related to the growing resources boom.
Strategies
8.1.1 Strengthen capacity of the health sector to report on notifiable diseases in accordance with international regulations. Increase the capacity of ARB to coordinate their responses to epidemic and population health emergencies.
8.2.1 Extend the functions of the current Buka Hospital laboratory to include public health laboratory functions.
Ensure it has sufficient capacity and supplies at all times to respond to disease outbreaks and other emergency health concerns.
8.2.2 Ensure a functioning and safe blood transfusion service is available to the health sector and includes HIV blood screening capability.
8.3.1 Actively engage in the resettlement process for climate change refugees to ensure their health needs are met.
8.3.2 Ensure every health facility has a disaster preparedness plan, which includes issues associated with climate change.
8.4.1 Develop an appropriate response to the health impacts of mercury and arsenic on miners and their families in the Panguna Basin.
33

Sector strategy 9: The ABG and GoPNG work together to promote a solid basis for an autonomous Bougainville health system
Objectives
9.1 Facilitate MOU on drawdown of health functions and powers from NDOH to ABG DoH.
9.2 Create Bougainville
Health Authority.
9.3 Implement Bougainville
Health Plan.
Strategies
9.1.1 National Government and ABG sign MOU.
9.1.2 Develop concept proposal on Bougainville Health
Authority (BHA) and commence legislative review.
9.1.3 Agree legislative framework for BHA with the national government.
9.2.1 Develop policy and legislative provisions to form the
BHA.
9.3.1 Establish and convene an independent advisory group to advise the Minister on the implementation of the
Bougainville Health Plan.
9.3.2 Report annually to the ABG parliament on the progress in implementing the Bougainville Health Plan.
34

Data presented in this section is incomplete. Data sources are indicated below each table.
Where available, 2010 Annual Sector Review data has been used because this data has been verified. It should be possible for ARB DoH to provide some of the missing data for the best and worst performing health facilities for 2011.This would help to provide a fuller picture of what is happening. ARB DoH should also confirm the suggested ARB Targets for 2015, particularly where these have not been extracted from the ARB MTDP 2011-2015.
Once the data is more complete ARB DoH should consider why these patterns are evident and what practical steps can be taken to improve performance in poorer performing facilities.
In many instances the knowledge on how to improve performance already exists within ARB.
Looking at practices where performance on a particular indicator is high can reveal practices that might result in better performance if adopted in other health facilities. There needs to be a good match between strategies outlined in the Bougainville Health Plan and activities that will improve performance against these indicators.
Health sector strategy 1: Improve service delivery
Objective: Increase access to quality health services for the rural majority
Indicator:
ARB 2011 1
Best ARB Region
2011
Average outpatient visits per person per year in hospitals and health centres
0.9
0.9 Buka – North Region and Buin – South Region
Best ARB Health 2.0 Sipai Health Subcentre
Facility 2011
Worst ARB Region
2011
Worst ARB Health
Facility 2011
PNG 2010 2
PNG Target 2015 3
ARB Target 2015
0.8
0.1
1.62
1.3
Kieta – Central Region
Panguna Health Subcentre
Sources:
1 ARB 2011 data from ‘North Solomons Province General (YTD) Report Jan to Dec 2011’ printed
4/3/122010
2 ‘Annual Sector Review North Solomons Province District Performance 2006-2010’
3 Not available
Outpatient visits in ARB are low at an average of 0.9 visits per person per year in 2011. The rate has been fairly constant over recent years. Many factors affect outpatient visits and it is difficult to determine why the rate in ARB is low compared with the PNG average. The rate may reflect factors such as accessibility, perceived range and quality of services offered
35

and/or preventive measures being taken at the individual or community level. Sipai and Tonu
HSCs both have high outpatient visit rates, exceeding the PNG average.
Health sector strategy 4: Improve child survival
Objective: Reduce malnutrition (moderate to high) in children under the age of 5years
Indicator:
ARB 2010 1
Best ARB Region
2010
Percentage of children under five less than 80% expected weight for age
22%
16% Kieta – Central Region and Buin South Region
Best ARB Health
Facility 2011 2
0% Buka Hospital, Boku Health Centre
27% Buka – North Region Worst ARB Region
2010
Worst ARB Health
Facility 2011
PNG 2010
PNG Target 2015 3
ARB Target 2015
73%
28%
26%
18%
Lenoke Health Subcentre
Sources:
1
ARB 2010 data from ‘Annual Sector Review North Solomons Province District Performance 2006-
2010’
2 ARB 2011 data from ‘North Solomons Province Child Health (YTD) Report Jan to Dec 2011’ printed
4/3/12
3 PNG MTDP 2011-2015
ARB performs better than PNG as a whole. But the percentage of Bougainville children aged less than 5 years who attend MCH clinics and weigh less than 80% of the expected weight for their age has been increasing since 2008. This is most notable in the North Region around Buka. In the south, the rate decreased from 2009 to 2010. The best-performing health facilities were Boku (0%) in the south and Gagan (2.4%) in the north. The indicator may reflect food availability and climate conditions as well as health and hygiene practices in the community.
36

Health sector strategy 4: Improve child survival
Objective:
Indicator:
ARB 2010 1
Best ARB Region 2010 60% Buka – North Region
Best ARB Health
Facility 2010 2
Worst ARB Region
2010
80% Buka – North Region
33% Kieta – Central Region 46% Kieta – Central Region
Worst ARB Health
Facility 2010
PNG 2010
PNG Target 2015 3
ARB Target 2015 4
Increase coverage of childhood immunization in Bougainville
Measles immunization coverage for children less than 1 year
63%
3 RD dose TA/pentavalent coverage at 12 months of age
63%
50%
73%
73%
51%
80%
73%
Sources:
1 ARB 2010 data from ‘Annual Sector Review North Solomons Province District Performance 2006-
2010’
2 Not available
3 PNG MTDP 2011-2015
4 ARB MTDP 2011-2015
For both measles and pentavalent coverage, Bougainville is performing better than PNG.
Rates generally decreased from 2006 to 2009 but have since begun to improve, particularly between 2010 and 2011. Improvements have been most evident in the North and South with virtually no change in Central Region. Bougainville ’s coverage was higher than the PNG average in 2010 but well short of the 2015 targets.
Health sector strategy 5: Improve maternal health
Objective: Increase the capacity of the health sector to provide safe and supervised deliveries
Indicator:
ARB 2010 1
Best ARB Region 2010
Best ARB Health
Facility 2011 2
Worst ARB Region
2010
Worst ARB Health
Facility 2011
PNG 2010
PNG Target 2015 3
ARB Target 2015 4
Percentage of supervised births at health facilities
56%
71% Buka – North Region
Antenatal coverage (at least 1 visit)
76%
91% Buka – North Region
115% Moratona Health Centre 287% Buka Urban Clinic
39%
1%
40%
54%
Kieta – Central Region
Konga Health Subcentre
65%
36%
62%
70%
Buin – South Region
Piva Health Centre
67% 91%
Sources:
1 ARB 2010 data from ‘Annual Sector Review North Solomons Province District Performance 2006-
2010’
37

2 ARB 2011 data from ‘North Solomons Province Maternal Health (YTD) Report Jan to Dec 2011’ printed 4/3/12
3 PNG MTDP 2011-2015
4 ARB MTDP 2011-2015
Bougainville performed better than PNG as a whole on both supervised deliveries and antenatal coverage in 2010. Rates for both these indicators, however, have dropped since
2007 except in the North Region where antenatal coverage increased considerably from
2010 to 2011. The main contributor to high rates of antenatal coverage in the north is Buka
Urban Clinic with a rate close to 300%. This rate suggests that people from other areas attend this facility and/or denominator figures are incorrect. Sipai Health Subcentre, Tearouki and Buin Health Centres all achieved over 100% antenatal coverage in 2011.
The decline in supervised deliveries has been most serious in Central Region. Buka Hospital is not reflected in the data above but provides over one quarter of all supervised deliveries.
All three regions are achieving less than the Maternal Health Taskforce recommended 80% supervised deliveries but several individual facilities are close to the recommendation.
Tearouki Health Centre and Monoitu Health Subcentre exceeded 100% of supervised deliveries. ARB has some way to go in order to achieve its 2015 targets for both these indicators and the key may be with these high-performing facilities.
Health sector strategy 5: Improve maternal health
Objective: Increase family planning coverage
Indicator:
ARB 2010 1
Best ARB Region
2010
Couple years protection per 1000 women aged 15-44 years
74
149 Buka – North Region
780 Buka Urban Clinic Best ARB Health
Facility 2011 2
Worst ARB
Region 2010
15 Buin – South Region
Worst ARB
Health Facility
1
2011
PNG 2010
PNG Target
2015 3
74
115
ARB Target 2015 115
Katuhkuh Health Centre
Sources:
1 ARB 2010 data from ‘Annual Sector Review North Solomons Province District Performance 2006-
2010’
2 ARB 2011 data from ‘North Solomons Province Family Planning (YTD) Report Jan to Dec 2011’ printed 4/3/12
3 PNG MTDP 2011-2015
38

In 2010 ARB performed at the same level as PNG for contraceptive prevalence coverage.
However, there is huge disparity between the North and the other two regions. There was a sudden increase in use of modern contraceptives in the North Region in 2009 and again in
2011. This has been attributed to the work of a female obstetrician who was based at Buka
Hospital from 2008 to 2011. Although awareness training was conducted in many parts of
Bougainville there has been very little change in the indicator in the Central and South
Regions from 2006 to 2010 and just a slight increase in 2011. Rates are well below the PNG average in Central and South Regions and work will have to be focused in these areas in order to reach the 2015 target.
Health sector strategy 6: Reduce the burden of communicable diseases
Objective: Reduce malaria related morbidity and mortality
Indicator:
ARB 2010 1
Malaria incidence per 1000 population
201
Best ARB Region 2010 92
Best ARB Health
Facility 2011 2
Buin - South Region
329 Buka – North Region Worst ARB Region
2010
Worst ARB Health
Facility 2011
PNG 2010
PNG Target 2015 3
ARB Target 2015 4
236
180
200
Sources:
1 ARB 2010 data from ‘Annual Sector Review North Solomons Province District Performance 2006-
2010’
2 Not available
3 PNG MTDP 2011-2015
4 ARB MTDP 2011-2015
Malaria has declined on Bougainville since 2006 although less so in the north than the other two regions. LLIN were distributed from 2006 and may have contributed to the reduction in malaria cases. The incidence of malaria in Bougainville is less than in PNG as a whole.
However, the Bougainville Health Plan sets ambitious longer term goals. A broader range of strategies implemented in all regions may be needed to achieve these targets.
39

Health sector strategy 7: Promote healthy lifestyles
Objective: Reduce the number of outbreaks of food and water-borne diseases
Indicator:
ARB 2010 1
Incidence of diarrhoeal disease per 1000 children less than 5 years
Best ARB Region 2010
166
114 Buin - South Region
Best ARB Health
Facility 2010 2
Worst ARB Region
2010
Worst ARB Health
Facility 2010
PNG 2010
PNG Target 2015 3
ARB Target 2015
228
276
100
Buka –North Region
Sources:
1 ARB 2010 data from ‘Annual Sector Review North Solomons Province District Performance 2006-
2010’
2 Not available
3 PNG MTDP 2011-2015
After slowly but steadily declining from 2006 to 2009 there was a sharp increase in diarrhoeal diseases in Bougainville in 2010, as was the case nationally. The increase was more pronounced in the North Region. Despite this increase, Bougainville continued to have less diarrhoeal disease than PNG. Water and sanitation will need to improve in all areas if the 2015 target is to be met. Hygiene may also need to improve.
Health sector strategy 7: Promote healthy lifestyles
Objective:
Indicator: population
ARB 2010 1
Increase health sector response to injuries, trauma and violence
Total injuries reported at health centre and hospital outpatients per 100
Best ARB Region 2010 12 Buin – South Region
Best ARB Health
Facility 2010 2
Worst ARB Region
2010
18 Kieta – Central Region
Worst ARB Health
Facility 2010
PNG 2010
PNG Target 2015 3
ARB Target 2015
14
33
10
Sources:
1 ARB 2010 data from ‘Annual Sector Review North Solomons Province District Performance 2006-
2010’
2 Not available
3 PNG MTDP 2011-2015
40

Rates of injury in Bougainville are considerably lower than the national average in all regions and have decreased between 2006 and 2010. Nonetheless, admission for the treatment of injuries ranks third overall in the ARB morbidity profile in 2010.
41

Strengthen health systems and governance
•Health sector coordination mechanisms in place
•Adequaccy of health funding
•Medicines supply to facilities
Strengthen partnership and coordination
•Bougainville Health Board operating effectively
•Health agreement part of extraction industry social licence
Improve service delivery
•Outpatient visits per year
•Villages served by active Healthy
Communities
•Geographical and financial access barrier measures
•Numbers of health workers
•Herbal medicine safe and effective use
Improve child survival
•Under five mortality
•Immunisation rates
•IMCI functioning at all facilities
Improve maternal health
Reduce communicable diseases
Prepare for disease outbreaks and new population health issues
•Family planning rate
•Maternal mortality
•Supervised deliveries
•TB, HIV, STI, malaria prevalence
•TB detection rate
•TB treatment rate
•HIV VCT acceptor rate
•ART and PPCT
•PH laboratory established
•Surveillance reports
Healthier lifestyles
Autonomous
Bougainville health system
•Rates of illness and death from injuries, cancers, diarrhoeal, cardiac and respiratory illnesses
•Fully functioning, effective Bougainville
Health Authority leading and coordinating the health sector and accountable to the
ABG
42

Document Health related goals/aspirations
ARB
Constitution
Vision 2050
ABG shall endeavour to ensure all people in Bougainville enjoy rights and opportunities and access to education, health services, clean and safe water, decent shelter, adequate clothing and food security.
Working in partnership with other bodies involved in pursuit of health objectives: a) promote primary health care b) pursue universal health care of the highest standard c) ensure the provision of basic medical services to the population d) promote water and sanitation management systems at all levels e) encourage people to grow and store adequate food f) encourage and promote proper nutrition, particularly for the young and the people of the Atolls, through mass education and other means g) recognize herbal medicines h) protect clans from HIV/AIDS
‘We will be a Smart, Wise, Fair, Healthy and Happy Society by 2050’
Millennium
Development
Goals
Goal 4: Reduce child mortality – improve child health.
Target 4.A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate.
Goal 5: Improve maternal health.
Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio.
Target 5.B: Achieve, by 2015, universal access to reproductive health.
Goal 6: Combat HIV/AIDS, TB, malaria, NCDs and other diseases.
Target 6.A: Halt by 2015 and begun to reverse the spread of HIV/AIDS
Target 6.B: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it
Target 6.C: Halt by 2015 and begun to reverse the incidence of NCDs and malaria
DSP 2010-2030 Achieve an efficient health system which can deliver an internationally acceptable standard of health services.
MTDP 2011-
2015
As per Development Strategic Plan 2010-2030
NHP 2011-2020 Goal: Strengthen primary health care for all, and to improve service delivery to the rural majority and urban disadvantaged. Focus on a ‘back to basics’ approach with rehabilitation of the foundations of our primary health care system focusing on improving maternal health, child survival and reducing the burden of communicable diseases.
Vision: of a healthy and prosperous nation that upholds human rights and our
Christian and traditional values, and ensures: Affordable, accessible, equitable, and quality health services for all citizens.
Mission: Improve, transform, and provide quality health services through innovative approaches supporting primary health care and health system
43

Document Health related goals/aspirations
Bougainville
Health Summit
2009 development, and good governance at all levels.
HSSP 2012-2015 As per National Health Plan 2011-2020
ABG MTDP
2011-2015
Goal: Better management, effective programs and healthier communities
Goal: Improved health status through quality and accessible health services.
Objective 1: Improve management and resources utilization.
Objective 2: Combat HIV/AIDS, malaria and other diseases.
Objective 3: Improve maternal and child health services.
Objective 4: Establish and strengthen partnership with communities/NGOs/donors.
Improve standard of curative health.
44

INDICATOR
Infant mortality rate
Under 5 mortality rate
Maternal mortality rate
Life expectancy
Incidence of tuberculosis
Incidence of malaria
Incidence of lifestyle and coronary diseases
Under 5s with moderate to high malnutrition
Number of hospitals in full operation
Number of functioning aid posts
Facilities with adequate medical supplies
Ratio of doctors per 100,000 people
Number of nurses
Number of
CHWs
Supervised delivery
Antenatal care coverage
Immunization coverage
Food outlets implementing the safe food code of practice
Baseline
47/1000 in
2000
62/1000 live births in
2006
123.5/1000 lives births in 2009
59.6 years in
2000
Indicators and targets from relevant planning documents
ARB Medium Term Development Plan 2011-2015
2015 Target
35/1000
46/1000
117/1000 live births
2020 Target
26/1000
37/1000
113/1000 live births
2025 Target
17/1000
27/1000
111/1000 live births
Millennium
Development
Goals
2015 PNG
Tailored target
44 per 1000 live births
72 per 1000 live births
274 per 100,000 live births
PNG
Development
Strategic Plan
2010-30
2030 Target for
PNG
Less than 17 per
1000
Less than 20 per
1000 live births
Less than 100 per 100,000 live births
Males 62.2
Females 62.7
Males 64.2
Females 64.7
Males 66.2
Females 67.2
70 years
158/100,000 in 2008
246/1,000 in
2008
153/100,000
200/1,000
127/100,000
154/1,000
122/100,000
108/1,000
Stabilized or reversed
Stabilized or reversed
Less than 150 per 100,000 people
Less than 100 per 100,000 people
N/A
1.20% in
2008
1 in 2011
180 in 2008
49% in 2008
5.5/100,000 in 2008
93 in 2008
229 in 2008
62% in 2008
86% in 2008
59% in 2008
N/A
N/A
1.1%
3
200
75%
8/100,000
300
500
67%
91%
73%
N/A
N/A
1.0%
3
210
80%
12/100,000
400
600
72%
95%
79%
N/A
N/A
0.9%
4
230
85%
17/100,000
500
700
77%
98%
87%
N/A
Keep incidence low
Less than 5%
50% of district health centres upgraded to hospital status
7500 in PNG
100%
50 per 100,000 people
200 per 100,000 people
20,000 in PNG
95%
100%
100%
90%
Sources: ABG MTDP2011-2015, p133; MDG 2nd National Progress Summary Report 2009 for PNG p131; PNG DSP 2010-2030 p48
45

Since the inception of the Traditional Health Project (THP) in July 2010, traditional medicine in Bougainville is gaining recognition and becoming better organized. The THP is a
European Union (EU), Austrian Development Agency (ADA) and Drei Königs Aktion (DKA) funded project. The project operates under the auspices of the Catholic Diocese in
Bougainville and HorizonT3000, helping with the preservation and safe utilization of local traditional medicines and practices. The THP supports and helps to implement the
Traditional Medicine Policy of PNG, the goal of which is ‘to improve and maintain health by providing easy access to safe and effective forms of traditional medicine and practices as part of the National Health Care System.’
Specifically, the THP aims to:

contribute to knowledge and appreciation of traditional health resources in Bougainville

contribute to improvement of health parameters, in particular maternal health, in
Bougainville

contribute to self sufficiency of Bougainville communities, in particular in rural areas, with respect to basic health

Preserve and continuously upgrade traditional health care knowledge and skills by introducing them into the modern health care system in Bougainville
The Bougainville Traditional Health Association (BouTHA) has been formed since the start of the THP. To date BouTHA has 300 members and 11 smaller associations representing districts or groups of villages. BouTHA’s dream is to strengthen the health service using safe and effective traditional medicine and practices and work with health staff to promote a healthy lifestyle.
In the short time since their inception, the THP and BouTHA have some notable achievements. Specimens from approximately 100 medicinal plants have been collected, analyzed and catalogued in conjunction with University of PNG and the Forestry Research
Institute. The information obtained will be used to produce a booklet on medicinal plants used in Bougainville for health centres, schools and the general public. Members of BouTHA have been trained as trainers in primary health care and over 500 traditional healers from all parts of Bougainville have received primary health care training. Bone-setters and massage therapists have received training on human anatomy and physiology. Traditional birth attendants upgraded their knowledge in safe motherhood and delivery. Twelve herbalists are attending a course on rural health management conducted by Divine Word University. Links between BouTHA and the Bougainville Healthy Communities Project (BHCP) have begun to
46

be established. BHCP includes training on herbal medicines as part of the training for volunteers and peer educators. Medicinal herb gardens have been established in primary schools.
In the future, the THP and BouTHA would like to establish more medicinal herb gardens at health centres and primary schools and include traditional medicine in the upper primary school curriculum. They want to establish a research institute and/or laboratory that can determine recommended doses for various herbal remedies. Other ideas include developing a quality control process for herbal medicines as well as techniques for mass production and preservation of herbal medicines. THP and BouTHA want to develop accreditation for traditional medical practitioners and collaborate more with health workers.
47

DRAFT ONLY
1. Overall ABG revenue estimates
Currently, the GoPNG has committed to providing 100 Million Kina per annum financial support to the ABG over a 5 year period. With low levels of internal revenue, this support is most important to the ABG, as the post-conflict recovery and development financial needs are considerable. The ABG has budgeted its plans for the period 2011-2015 to meet certain development priorities, as indicated below.
Table 1: Estimated revenue required to finance ABG
’s priorities for development 2011-
2015 in kina (millions )4
Grants (external)
Internal revenue
Total
2012
84.8
22.5
107.3
2015
92.2
24.8
117.1
Currently, it is estimated the ABG generates about 5 million kina per year through taxes.
These taxes are collected by the GoPNG taxation system with some returned directly to the
ABG, under current agreements. The 2012 and 2015 budgets given in Table 1 assume a significant increase in taxation revenue over the 2012-2015 period. This taxation base includes group tax on wages, a goods and services tax, motor vehicle registration fees, liquor licensing fees, and excise taxes on alcohol and tobacco. The excise taxes are new and the ABG is hopeful of large revenue gains from these taxes into the future.
The GoPNG also provides financial support to the ABG health sector by funding the Buka
Hospital, salary support for rural health services, financial support for the Church health services and provision of medical supplies (see below).
4 The Bougainville Administration, pages 71-72
48

There is uncertainty over what level of support would be provided by the GoPNG in the longer term, after a referendum is held to determine if the ABG would continue as an autonomous government within the PNG Government, or as an independent nation.
2. Health sector recurrent expenditure estimates
The estimated recurrent expenditure of the ABG health sector is financed from a number of sources, as given below.
Table 2: Estimated recurrent expenditure ABG health 2012 (Kina 000’s) 5
Buka Hospital
Church health
Rural Health
GIF Maintenance (Aust, NZ)
HIV funding
MSF
Rollover
Med supplies est
Maintenance costs 11
DHFF (est) (NZ –HSIP)
Leprosy Mission Health (NZ –HSIP)
Total
8.93
6
3.74
7
3.72
8
0.9
0.2
2.14
9
0.076
5.6
10
0.36
0.9
12
0.96
13
27.53
Of this 27.53 million kina estimated recurrent expenditure, ABG directly contributes an estimated 1.355 million kina in recurrent expenditure. The rest is made up of donor contributions (4.90 million kina) and GoPNG funding (21.27 million kina). The GoPNG is by
5 Autonomous Region of Bougainville, Health Capacity Diagnostic Report (March 2012) Pages 20-21.
6 An estimated 300,000 kina in revenue added to the quoted figure of 8.6 million kina. Source: Health
Sector Partnership Committee, Agenda Papers (Feb 2012) Page 20.
7 Health Sector Partnership Committee (February 2012) Page 34.
8 Made up of staffing costs of K3 million, recurrent funding of K0.426 million and operational funding to
13 DHCs of K0.29 million. – Source: Autonomous Region of Bougainville, Pages 19-21.
9 MSF Funding is 800,000 euro per year for 4 years (verbal source) = 2.14 million kina per year at 1:
2.67 exchange rate, as at 13 April 2012 – Source www.xe.com
.
10 Based on overall PNG medical supplies and equipment spending divided by the population estimate and indexed for the ABG population. (awaiting an alternative estimate from NDOH).
11 Included in 2011 Restoration and Development Budget rollover – Source: Autonomous Region of
Bougainville, Pages 22-23.
12 Based on verbal discussions with NZAID that DHFF expenditure for 2011 was just short of 1 million kina. DHFF is the Direct Health Facility Funding program (awaiting an alternative from NDOH).
13 Source: Health Sector Partnership Committee, Agenda Papers (Feb 2012) Page 20.
49

far the major contributor to health sector recurrent funding, and is likely to remain so until sometime between 2015 and 2020. Within this five year period, the referendum has to be held, after which GoPNG funding will be uncertain.
50

Table 3: Details of recurrent expenditure by contributing entity
ABG contribution
Operational costs for 13 health centres
Health Division recurrent exps (not salaries
HIV funding
Rollover of recurrent costs from 2011
Maintenance costs from restoration and development
Budget rolled over from 2011
Sub-total
GoPNG contribution
Buka Hospital expenses (inc. revenue)
Church health services
Rural Health staffing costs
Medical supplies (est)
Sub-total
Total government contributions to recurrent funding 2012
Donor contributions
Maintenance (GIF)
MSF
DHFF (NZ through HSIP)
Leprosy Mission Health (NZ through HSIP)
Sub-total
Total Estimated Recurrent Expenditure 2012
3. ABG health sector capital expenditure estimates
For 2012, ABG is providing 4.5 million kina in capital funding for health infrastructure, as part its 100 million kina per year (for 5 years) grant from the GoPNG.
Kina (millions)
0.29
0.426
0.2
0.076
0.363
1.355
8.93
3.74
3.0
5.6
21.27
22.625
0.9
2.14
0.9
0.96
4.9
27.53
51

Table 4: Estimated capital funding ABG from various sources 2012
Capital Funding – ABG Infrastructure
ABG (PIP) Restoration and Development Grant 2012
Restoration and Development Grant 2011 rolled over 15
Total Government sourced capital funding
Donor contributions (capital - RHSDP) 16
Total estimated capital funding for 2012
Kina (millions)
4.50
14
1.593
6.093
2.93
9.023
4. Total estimated expenditure from government sources 2012
This consists of GoPNG recurrent funding, and ABG sourced recurrent and capital funding, as indicated earlier.
Table 5: Estimate of total government sourced funding ABG 2012
Kina (millions)
Total government contributions to recurrent funding
Total government sourced capital funding
Total 28.718
Total government sourced expenditure per capita (Using the
ABG population estimate of 239668 17 )
Total government sourced expenditure per capita 18 in US$
119.82 Kina
58.59 US$
22.625
6.093
14 Autonomous Region of Bougainville, Health Capacity Diagnostic Report (March 2012) Page 21
15 2011 Restoration and Development Budget rollover – Source: Autonomous Region of Bougainville,
Pages 22-23. Note: 1.593 mill kina is capital funding, 0.363 mill kina is recurrent.
16 ADB Infrastructure Program of US$82 mill over 8 Provinces, 70% spent in Province over 5 years.
17 Source: National Statistical Office of PNG, PNG Census 2011, Preliminary Figures of 234,280 indexed up to 2012 by 2.3% estimate only, Page 5.
18 Using exchange rate of 1 kina = 0.489 US$ - Source www.xe.com
.
52

5. International comparisons - Per capita government health expenditure US$ 19
In the chart below is a comparison of US$ per capita government sourced health expenditures of PNG overall, other Melanesian Pacific countries and ABG. Whilst ABG appears to be higher than PNG overall, it falls well short of the per capita health expenditures of the Solomons, Fiji, Kiribati and Vanuatu.
Table 6: Other countries per capita government sourced expenditures
Philippines
Timor Leste
Indonesia
Thailand
Tonga
Samoa
Malaysia
New Zealand
Australia
27
32
38
134
140
179
204
2728
3246
It should be noted there are limitations to the accuracy of these indicators, as they are dependent on data sourced from each country. However, WHO has gone to some length
19 National Health Expenditure Indicators WHO 2010. Note: General government health expenditures as given by WHO, include capital expenditures. They are collected from national health accounts, when available, and other government sources – refer to WHO website: http://www.who.int/healthinfo/statistics/indhealthexpenditure/en/index.html
.
53

over at least ten years to standardise data collection and methods of calculation, to allow more meaningful comparisons. There are other methods of comparison which take into account relative purchasing power in each country, but in the interests of not over complicating the comparisons (since they are a guide only) this has not been done in this document. Notwithstanding limitations of inter-country health expenditure comparisons, it is useful to compare government health spending per capita of ABG’s Melanesian neighbours.
The ABG is currently quite close to the US$60 per capita level, which the WHO has determined would provide enough financing for a health system in a developing country to deliver all of the specified mix of interventions to treat conditions to meet the health
Millennium Development Goals (MDGs) and interventions targeting non-communicable diseases.
20 However, it will be important over time that the ABG tries to increase its government-sourced health expenditure to levels comparable to other Melanesian countries, in order to improve its health services overall, as well as using ongoing workforce and health system productivity gains.
6. Government-sourced health expenditure growth scenarios
Up to 2015, the ABG can rely on its own funds (using the 100 million kina per year GoPNG grant) and GoPNG funds to finance its needs for health and other government expenditures.
Beyond 2015, it is uncertain where the sources of government expenditure will come from, and this is dependent on the outcomes of the referendum. At the moment, GoPNG collects tax on behalf of ABG and returns an agreed proportion back to ABG. If ABG remains autonomous, it is uncertain to what extent and how long it will take for overall taxation imposition and collection responsibilities to transfer to ABG. If ABG becomes an independent nation, this date will be reliant on the date of the referendum (between 2015-2020) and the time it takes to totally transfer powers, including all taxation responsibilities. So between
2015 and when there develops a significant revenue stream for the ABG, possibly from 2020 onwards, when the Panguna mine starts to generate revenue, the ABG will need to find a way to finance its government services, including health. If it becomes independent, it can do
20
From World Health Report 2010 chapter 2 pages 22-23
54

this partially by taking over taxation powers from GoPNG at the time when PNG stops providing government funding.
With this uncertain context in mind, three financial scenarios for ABG Health are given below. The expenditure figures include both recurrent and capital expenditures.
Scenario 1: Total government sourced expenditure rises only to match population increases – so that per capita expenditure stays constant
Up until 2015, GoPNG have committed 100 million kina to ABG, of which it is understood, the ABG Health division will receive 15%, that is 15 million kina.
In this scenario, expenditure would increase from 2012 to 2013, because of the 15 million kina introduced to the ABG budget in 2013, and this would stay the same until 2015. From that point on, expenditure, it is assumed wholly funded by ABG, would stay at the 2015 level of US$69.12 per capita, but increase with population increases. So whilst the budget would increase by 2.3% per year to 2020 and then by 2.0% to 2030, it would only be rising with population increases and there would be no real per capita increase in expenditure.
21
Expenditure stays at
US$69.12 per capita
21 For the purposes of these scenarios, it has been assumed population will increase by 2.3% to 2020 and then by 2.0% to 2030.
55

This scenario would mean that by 2030, expenditure per capita would still be well below the per capita expenditure of ABG’s southern Melanesian neighbours. These countries range from US$100 to US$143, with a crude average of US$120. This expenditure scenario would in effect mean that ABG Health would remain severely underfunded and would most likely not reach its desired health status targets.
Scenario 2: Bring ABG health expenditure up to US$120 per capita by 2030 on a steady basis with a 5.92% increase per year
Likely funding gap period
US$120 per capita by 2030
US$100 per capita by 2025
If the ABG decided to reach an expenditure target level of US$120 per capita by 2030, it would require a percentage increase in annual expenditure from 2015 of 5.92%. It would not reach US$100 per capita until 2025. With this scenario, it assumes that GoPNG expenditure would cease by the end of 2015, and from that date onwards the funding would come from
ABG sources. This includes both recurrent and capital funding.
Scenario 3: ABG achieves US$100 per capita government health expenditure 5 years earlier than scenario 2, by 2020, and a US$120 per capita health expenditure by 2030 .
This means ABG would need to have higher percentage annual increases in the first 5 years to achieve the US$100 per capita target earlier. To achieve these expenditure targets, it would require an annual percentage increase in the health budget of 10.14% to 2020, and a
3.87% increase from 2020 to 2030 (as indicated by the more gradual curve in the graph after
56

2030. Whilst this scenario allows achievement of the US$100 target earlier, it also means a much higher percentage increase in funding in the 5 years from 2015, just in the time period of likely funding uncertainty.
US$100 per capita by 2020
US$120 per capita by
2030
Likely funding gap period
Summary
Scenario 1 would not allow ABG to be sufficiently funded to reach its health status objectives. Scenario 3 puts too much pressure on funding requirements in the period 2015 to
2020, which is the period of most funding uncertainty. Scenario 2 has a more modest but steady growth of 5.92% per annum, and allows for a funding target of US$100 per capita to be achieved by 2025 and US$120 per capita by 2030. Scenario 2 is the most optimum.
7. The recurrent and capital expenditure mix
Because the WHO international comparisons of government-only financial sources quoted above use both capital and recurrent expenditures combined, so too does this analysis. This allows projections of target dates for US$100 and US$120 to be developed. However, in practice, capital and recurrent funding needs to be separated. With the steadily increasing overall health budget that Scenario 2 outlines (5.92% per annum) from 2015 to 2030, there is scope to utilise some of the increase for recurrent and some for capital purposes. Because recurrent health expenditures are generally non-flexible downwards (they can only generally rise or stay the same, because of locked in recurrent costs like wages and other program commitments) it is useful to project recurrent costs based on Scenario 2 (5.92% growth) and
57

the 2012 recurrent expenditure estimates. These projections can act as a tool for recurrent expenditure growth using 2012 as the baseline expenditure.
The graph of estimated recurrent health expenditure to 2030 is given below. Between 2012 and 2015, it rises from 28.72 million kina to 36.27 million kina, due to the commitment of
GoPNG providing the 15 million kina per annum to ABG and the GoPNG providing most of the recurrent health funding. From 2016, there is a steady 5.92% increase. However, as indicated in the graph, ABG’s contribution will need to rise dramatically from 2015 to 2016, from 8.093 million kina to 38.42 million kina , to replace the loss of 21.27 million kina which up until then would be provided by GoPNG. This situation would arise if ABG was an independent nation from 2015 onwards. This may or may not be the case, but this assumption has been made in this document to indicate the possibility of the most critical funding situation occurring. ABG needs to prepare for such a possibility, given that a referendum could occur as early as 2015.
Note – See Table below for inflation adjusted data.
As a guide to funding needs to ensure a steady 5.92% growth to 2030, the data has been provided in Annex 1, also with Kina funding needs taking into account inflation changes.
Capital funding spending can be projected in a similar way using the 2012 government sourced capital funding estimate as a base. However, this baseline figure for 2012 of 6.093 million kina may or may not be appropriate, and given the need to upgrade health facilities
58

over the next few years, it is probably inadequate. However, the capital funding projections could act as the minimum required per year to ensure the total government sourced expenditure (recurrent and capital) reaches the US$120 per capita target by 2030.
In the next few years (probably beyond 2020) ABG could source significant extra capital funding from its own resources, especially when the government tax and mining royalty revenue base starts to climb. However, in the intervening period, from now to 2020 at least, external sources of additional capital funding will be needed to finance planned restoration and capital development projects in the health sector (e.g. hospitals and health centres and their equipment requirements).
Note – See Table below for inflation adjusted data.
9. Recurrent and capital expenditure projections taking into account losses in purchasing power due to inflation
Inflation rates within an economy are an indication of rising prices but not extra resources, whether they be staffing, operational costs, medical supplies, transport and other recurrent expenses. Because of inflation, the same resources cost more, and that is why expenditure data needs to be adjusted by the inflation rate, which is a crude average of the rise in prices of the same number of goods and services.
59

In the graph and table below, the recurrent and capital expenditure increases projected to
2030 at 5.92% per year, in order to reach a total expenditure target of US120 per capita, have been adjusted for inflationary price increases. These are the increases which can be used to guide recurrent and capital budget increases into the future to achieve the
US$120 target by 2030 . However, the figures are a guide only and should be treated within the context of the objectives of the Health Plan, taking into account over time emerging funding requirements and the limits of funding availability.
For the purposes of the projections a long term 6% inflation rate is used.
22
22 This is used given the latest rates of suppliers of goods and services vary from 2.9% to 11.7%
(Australia 2010 2.9%, PNG 2010 6.8%, China 2010 5%, and India 2010 11.7%). Source: http://www.indexmundi.com/
60

Table 7: Inflation adjusted ABG health recurrent and capital expenditures needed to ensure a 5.92% steady growth rate in real terms – to achieve a US$120 per capita (in real terms) expenditure target by 2030 23
Year
Total recurrent expenditure
(2012 kina millions)
Total capital expenditure
(2012 kina millions)
Total expenditure
(2012 kina millions)
Total recurrent expenditure needed to offset 6 % inflation
Total capital expenditure needed to offset inflation
Total expenditure needed to offset inflation
2012 22.63
2013 30.18
2014 30.18
2015 30.18
2016 31.96
2017 33.85
2018 35.86
2019 37.98
2020 40.23
2021 42.61
2022 45.13
2023 47.80
2024 50.63
2025 53.63
2026 56.80
2027 60.16
2028 63.72
2029 67.49
10.27
11.53
12.95
14.53
16.32
18.32
6.09
6.46
6.85
7.26
8.15
9.15
20.57
23.09
25.93
29.11
32.68
36.70
50.87
57.11
64.12
71.99
80.82
90.74
22.63
31.99
33.91
35.94
40.35
45.30
101.88
114.38
128.42
144.18
161.87
181.74
43.10
45.65
48.35
51.21
54.24
57.45
28.72
36.27
36.27
36.27
38.42
40.69
60.85
64.45
68.27
72.31
76.59
81.12
7.24
7.67
8.12
8.60
9.11
9.65
6.09
6.09
6.09
6.09
6.45
6.84
10.22
10.83
11.47
12.15
12.87
13.63
2030 71.49 14.43 85.92 204.05 41.20 245.24
23 Note $120 per capita expenditure in 2012 dollars is equivalent to S342 per capita in 2030 dollars.
120X(1.06) 18 = US$342.52. If this is divided by 0.489 to convert to kina and then multiplied by the projected population in 2030 of 350,443 the answer is 245,467,000 kina. This is the same as the projected total expenditure inflation adjusted in the table above (rounding off explains the small difference).
61.14
68.64
77.06
86.52
97.14
109.06
28.72
38.45
40.75
43.20
48.50
54.45
122.45
137.47
154.35
173.29
194.56
218.44
61

10. Staffing needs to develop an accounting and finance capacity for ABG Health
It will be important to further develop the accounting and finance capacity of AGB Health by employing and/or training a suitable person to oversee and manage the ABG health sector finance system. Ideally, this person would be a qualified accountant, eligible to be a member of one of the professional accounting bodies recognized in PNG. This would normally require at least a diploma in accounting or business studies with major studies in accounting. It would also be useful for this person to have some training in economics. This person could service the health sector by either working in the overall administration of ABG, but dedicated to the health services, or working specifically within a proposed health department, whichever structure may emerge.
11. Health Commitment Table 2012-2030 ABG Health
This table is provided as an accompanying excel spreadsheet. ( Health Commitment Table to
2030.xlsx
) It can be used as a finance planning tool for ABG Health. The table indicates on an annual basis the funds available for planned increases in recurrent and capital expenditures, and what available funding can be carried forward for later years. It is a flexible Excel table and can have different financial inputs to the ones utilised currently.
It assumes that funds available in 2012 are fixed and committed. From 2013 to 2015, the recurrent funding increases as a result of the 15 million kina made available and committed to ABG Health from the ABG.
This forms the basis of committed funding at 2015.
From 2016 onwards it is assumed there will be no more funding from GoPNG and that all funds are from the ABG. It is also assumed that from 2016 onwards this funding will increase by 5.92% per annum to 2030. This funding can be used for recurrent or capital spending.
Increased expenditures as per the Health Plan priorities are then matched against these steady annual increases in funding. These expenditures are included as sufficient funding becomes available.
It is assumed that when recurrent expenditures are included, they then form the basis of an increased recurrent expenditure base (i.e they stay in the recurrent budget in following years).
62

When capital expenditures are included, they may be included partially over a number of years, depending on funding available each year, or if small enough they are completed in one year.
When capital expenditures do span more than a year, related recurrent funding is added partially over those years to reflect the amount of the project completed and operating.
When a capital expenditure is completed by the end of a year, it is assumed that the full recurrent spending relating to it will occur in the following year and will then continue annually.
63

Plan timetable and financial impact (Draft 20/04/12)
Event
Health goals
Measles elimination*
MDG 5 compliance*
Begin Complete Comments/
Impact
2012 2015?
95% measles vaccine coverage in all regions for 2 years. Other
WHO criteria to apply before elimination can be declared.
2012 2014?
2012 2018?
Meet criteria set by Maternal
Health Taskforce.
MDG 4 compliance*
Universal health coverage*
2012 2019?
Malaria elimination ?
Free, accessible primary health care for 99% of
ARB population.
WHO criteria for elimination.
Health services
Essential obstetric care in all health centres and community health posts
Maternity/ midwife training program for all existing staff involved in deliveries
2012 2014?
2014?
2012 2013
All deliveries conducted by trained NO/CHW.
Maximise the potential of existing staff.
Training needs assessment and training program developed and implemented for all existing staff
ABG tobacco free policy and practice
ABG home brew and alcohol PH program
Develop and implement nutrition strategy to address first 1000 days and NCDs
2013?
2020?
2014?
2018?
2014?
2020?
Capital
See DHFF
DHFF
RHSD funding
RHSD funding
RHSD funding
Recurrent
See DHFF
Nil
0.2
1m
64

Plan timetable and financial impact (Draft 20/04/12)
Event
Medical supplies move to
Pull system
Decision on medicines purchasing options for
ABG.
Begin Complete Comments/
Impact
2013?
2014?
2014?
Improved medical supplies
Assess impact of
2013?
current approaches and move to Improved medical supplies.
Buka Hospital re- accreditation
Diagnostics – Digital Xray established in 2 district hospitals
Integration of BHCP into health services and coverage of all villages
Introduction of pneumococcal vaccine
2020?
2013 2014?
2014?
2015?
Reduced child admissions for pneumonia
Medical supplies, and equipment electronic inventory and ordering system
Integrated Information system linking all levels and facilities
DHFF facility level funding and removal of user fees.
2012 2019?
2011 2013
2013?
2025?
Increased utilisation, increased performance at facilities.
Drs deployed to districts and major facilities – increasing skills in facilities.
Buildings
STI clinics (2) 2012 2012
Rural Health Service
Delivery rural health infrastructure upgrade
2012 2016?
At Buin and
Arawa. AusAID project currently underway.
Rural Health
Service delivery project currently
Capital
GoPNG funded
Neutral
1m
Already committed
Already committed
Recurrent
1m
3.3M
65

Plan timetable and financial impact (Draft 20/04/12)
Event
CHW training school establishment
Arawa District Hospital
Development
Begin Complete Comments/
Impact
?2012
?2015
2018
2020 covers South and
Central and is underway.
Additional support required for North region’s rural facilities.
Increased availability of
CHWs. Cost approx K10m.
Cost of new
?2020
2022
District Hospital
$25m.
Cost $5 -10m per site.
Rural Hospital development Tanamalo,
Moratona
Buin Hospital development
Development of Buka
Hospital as provincial hospital
?2016 2021
2022 2029
2023?
2030
Cost K10m
Cost K100- 120m if new site required.
Nursing school development
Children’s hospital development
Governance and management
Establish Health Plan
Independent advisory group
Post 2030
2012 2012
Establish Bougainville
Health Board
Establish Bougainville
Health Authority
2012 2012
2012 2014
Advises Minister on progress of this plan.
Coordinating mechanism for health sector organisations
( c hurch, hospital, rural, NGO).
Merger Rural
Health and hos pital services.
Capital
K10m
K25
K10m
K10m
K120 m
Recurrent
K2m
66
K5m
K2m
K2,2
K20m

Evidence based business cases should be prepared for all projects exceeding PNG K1 million. Business cases should respond to the criteria below.
PRIORITIZATION
In determining priorities, the health sector will assess various options, by applying and considering the following principles.
1. Equity
2. Impact
3. Disability adjusted life years (DALYs) gained
4. Technical feasibility
5. Effectiveness
6. Efficiency
7. Cost
8. Opportunity cost
9. Sustainability
10. Consistency with health sector values
11. Cultural acceptability
TIMEFRAME FOR IMPLEMENTATION
In determining when various strategies should be implemented, the health sector will consider the following principles.
1. Time to benefit
2. Pre- requisites in order for strategy to be viable/beneficial. (personnel, finances)
3. Benefit of small scale introduction before expansion and roll-out
4. Recurrent cost of maintaining strategy and how this affects ongoing annual expenditure
67

This plan was prepared following direction given by the Vice President & Minister for Health of ARB, The Honourable Patrick Nisira and from four days of discussion with a technical advisory group from the ARB health sector and consultation with a wide range of stakeholders.
Plenary sessions were attended by:
Laurence Disin, ABG Chief Administrator
Raymond Masono, ABG Deputy Administrator
Members of the technical group:
1. Dr Pumpara, CEO, ARB Health Division
2. Dr Imako, CEO, Buka General Hospital
3. Simon Disin, Director of Policy, Planning and Administration ARB Health Division
4. Alois Pukienei, Director of Public Health, ARB Health Division
5. Matthew Monei, Director of Corporate Services, Buka GH
6. Vincent Momei, Environmental Health, ARB Health Division
7. Michaelyn Pau, Catholic Church Health Secretary
8. Rev Abi Enoh, United Church Health Secretary
9.
Hona Nolan, Women’s Representative,
10. Puara Kamariki, CEO for Human Resource, ARB
11. Maria Cartwright, NGO Health Rep, MSF
12. Ruby Mirinka, Bougainville Healthy Communities Program
13. Aileen Pilau, Health Information Officer
14. Peter Awin , Health Centre
15. Ms. Agnes Titus, UNDP
16. Ross Naylor, Health Economist
17. Dr Isaac Ake, Health Sector Expert and NDoH Representative
18. Dr Joan Macfarlane, Public Health Specialist
19. Prof Don Matheson, Health Planning Specialist and Lead Adviser
Stakeholders Consulted:
Vice President & Minister for Health ARB:
Secretary of Health
NDoH Strategic Policy Division :
Technical Adviser, Health Economics,
Senior Planner (Strategic)
Facilities branch
Asian Development Bank:
WHO Representative:
PNG Finance Consultant :
ARB CEO Finance,
The Honourable Patrick Nisira
Pascoe Kase
Navy Molou
Roselyn Melua,
Mr Ambrose Kwaramb.
Rob Akers
Dr William Adu-Krow
Dr Paulinus Sikosana
Dr Mohammed Salim Reza
Gima Ruba
Graham Kakaroutz
68

CEO Planning and Aid Coordination
GoPNG Secretary of Treasury
AusAID
UNICEF, Chief, Child Protection,
NZAID New Zealand Program Aid Manager
UNFPA, Assistant Representative
World Bank Human Development Operations
Lesley Tseraha
Simon Tosali
Dr Geoff Clark
Elaine Bainard
Dr. Grace Kariwiga
Rebecca Lineham
Dr Gilbert Hiawelyer
Ms. Ellen Kulumbu
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