Health expenditure and performance in Papua New Guinea

Health expenditure and performance in Papua New Guinea Colin Wiltshire, Amanda H A Watson Denise Lokinap & Tatia Currie

Presentation Outline 1. Outliers in health survey data – East New Britain and Gulf province 2. Method and approach to case study research 3. Outline major health policies and preliminary findings on: – Health clinic financing (recurrent and development) – Free Primary Health Care Policy – Medical and drug supplies policy 4. Conclusion 2

Comparisons of health clinic characteristics Percentage of health clinics with access to an ambulance (including boat) Percentage of health clinics with electricity 100% 90% 80% 70% 60% 59% 60% 50% 40% 30% 20% 10% 67% 3% 0% 15% 10% 0% East New Britain Gulf 3

Comparisons of health clinic budgets Clinics preparing budgets and plans 100% 90% Clinics receiving funds from budgets 100% 90% 85% 80% 70% 60% 50% 40% 30% 18% 20% 10% 33% 20% 9% 10% 0% East New Britain Gulf 4

Comparisons of health fees raised Clinics that charge user fees 100% Average annual user fees raised K 14, 000 12, 240 90% K 12, 000 80% K 10, 000 70% 60% 54% K 8, 000 50% K 6, 000 40% 30% K 4, 000 20% K 2, 000 10% 0% 1, 311 K 0 East New Britain Gulf 5

Comparisons of health activities performed Health centres that conducted more than five patrols Carried out maintenance of health clinic or staff housing 100% 90% 80% 70% 60% 50% 46% 50% 40% 30% 20% 10% 52% 3% 0% 26% 10% 0% East New Britain Gulf 6

Methods and approach to fieldwork • Mixed methods research (surveys, interviews and focus groups. • In East New Britain province, research teams visited Pomio and Gazelle districts • In Gulf province, fieldwork was conducted in Kerema and Kikori districts. • For each district, one of the best performing health clinics was sampled and one of the poorer performing health clinics. 7

Increases in the health function grant 2003 – 2016 (Kina Millions) K 120 K 110 K 100 K 90 K 80 K 70 K 60 K 50 K 40 K 30 K 20 K 10 K 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Sources: PNG national budget documents (PNG Treasury 2004 – 2014). 8

Provincial Increases in health function grants 2007 – 2016 (Kina Millions) K 12 10. 7 K 11 K 10 K 9 K 8 K 7 6. 12 K 6 5. 01 K 5 4. 29 3. 88 K 4 K 3 3. 25 K 2 1. 26 1. 25 K 1 K 0 2007 2008 2009 Sandaun 2010 2011 Gulf 2012 East New Britain 2013 2014 2015 2016 Morobe Sources: PNG national budget documents (PNG Treasury 2004 – 2014). 9

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CDF changes over electoral period 2012 -2017 K 1, 600 K 1, 400 K 1, 200 K 1, 000 DSIP K 800 DSIP (DHIP+DEIP) K 600 K 400 PSIP K 200 LLGSIP K 0 2013 2014 2015 2016 2017 Sources: PNG Treasury (2013; 2016) 11

Free Primary Health Care Policy ‘health services are already weak in PNG and this free health policy could collapse the system’ (Senior NDo. H Official, 2014) 12

Average annual user fees raised by clinics (2012) K 14, 000 12, 240 K 12, 000 K 10, 000 K 8, 000 6, 998 6, 772 6, 696 Church Government K 6, 000 K 4, 000 K 2, 000 1, 311 K 0 All East New Britain Gulf 13

Medical supplies policy Tender bids for procurement of health centre medical supply kits in PNG Source: Tefuarani and Mola (2013) 14

Changes in the availability of common drugs at revisited health clinics in East New Britain 100 90 80 70 60 2012 50 2016 40 Avg 30 Avg 20 10 0 Health Clinic 1 (Pomio)Health Clinic 2 (Pomio) Health Clinic 3 (Kokopo) Health Clinic 4 (Kokopo) 15

Conclusion • PNG Government’s major health policies have become increasingly politicised and are experiencing significant difficulties in implementation. • This data points to a worrying trend based on a small sample. • Broader and more representative research is required. • Full report to be released soon. 16