Strengthening Church and Government
Partnerships for Primary Health Care
Delivery in Papua New Guinea: Lessons
from the International Experience
HPHF Hub Technical Review Meeting
Judith Ascroft : Monday 10 October 2011
What is the issue ?
• CHS providers manage up to 50% of rural
and remote facilities in Papua New Guinea
– 6 of 9 nurse training facilities
– 14 training facilities for community health workers
• The relationship between church health
service providers and government in PNG
has been described as ‘weak’
– No formal agreement in place
• Research aimed to understand differences in
service provision, the nature of the
engagement and opportunities to strengthen
the relationship
Research Questions
1.What makes primary health care service provision by
church based organisations different to government
health service provision?
2.What are the characteristics of existing arrangements
for governments to engage non-government, non-profit
providers of primary health care services?
Background and Context
• PHC facilities are the predominant point of access to the
health system for 87% of the population in PNG
– Infectious diseases and maternal and child health greatest burden
• Health system decentralised and fragmented
– Disconnect between programs, priorities, service providers and levels of
govt
• PHC service provision has deteriorated
– Minister “Our health indicators have not improved over the past 10 years”
– MMR – 733 per 100,000 live births
• Government grants make up to 70-100% of total funding to
CHS
– Many attempts to develop MOUs, MoAs, and CHS Act to provide a legal
framework for an agreement
Approach/Methodology
• Research questions identified through working group
meetings – Knowledge Hubs, AusAID, NDoH, CMC
• Literature Review training for research partners at
Divine Word University (plus NDoH)
• An empirical study based on a literature review of
international peer reviewed and grey literature
• Search strategy broad enough to identify evidence
relevant to one or both research questions
• Focus PHC in developing countries and relationships
between not-for-profit health service providers
Limitations
• Predominantly descriptive case studies and program
evaluations
• Studies selected on the basis of relevance to
research questions but no quality assessment
• Key themes were identified for each research
question but no detailed description or critique of
each paper
• Little evidence specifically identifying differences –
demonstrated through discussions of strengths and
weaknesses of CHS or Govt
• Cannot draw a broad conclusion that CHS are better
or worse in a given situation
Overall Findings
• A range of challenges in effective stewardship of
mixed systems in countries such as Papua New
Guinea
• Examples of strong collaboration but also strains on
CHS in some African countries
• Critical factors:
– high level support from MoH;
– willingness of CHS providers to fully support
implementation of NHP and policies;
– strong, trusting partnership working for the benefit
of the overall health system;
– an enabling environment in which the partnership
can flourish
Key Findings
• Issues with the health system ‘building blocks’ of
leadership and governance, financing, health
workforce, and service delivery eg:
– CHS can be isolated from national policy and
planning
– Reluctance to adopt national policies eg related to
family planning
– A lack of transparency and consistency in
financing of CHS
– ‘Competition’ for human resources, salary
differences, restrictive hiring practices
– Differences in culture and management styles that
can impact on ‘trust’
Key Findings (contd)
• Complex relationship between faith and health influences both health seeking behaviour and health
service provision
• Relational contracts have been used to build trust
and reduce costs of managing and monitoring
‘classical’ contracts
• Important to create conducive conditions for
successful contracting – legal framework, discourage
corruption, capabilities to use programmatic,
administrative and financial data, functional HIS
• ‘Incomplete’ decentralistion and poor
communications can impact negatively on
partnership
Factors which can be built on to enhance the
partnership in PNG
• PNG has a number of strategies, structures, policies and
systems in place
– Framework of new NHP 2011-2020
– Provincial Health Authorities Act 2007
• Recognising CHS as NFP public sector partners
• Responding to local contexts within the framework of national
policies
• Assured funding commitments (Govt) and improved
transparency (CHS)
• Involvement in policy, planning and implementation of agreed
standards
• Utilising the strengths of CHS in training
• Acknowledging and managing differences in culture and style
• Accessing support from development partners to enhance the
partnership
Thank you
• Questions?