Research report: Examines the current reform process in Papua New Guinea's health sector from a capacity development perspective.
Authors: Joe Bolger, Angela Mandie-Filer and
This report examines the current reform process in Papua New Guinea's health sector from a capacity development perspective. It addresses a number of factors influencing capacity development, change and performance in the sector, including issues internal to the National Department of Health (NDoH), capacity issues at sub-national levels, the institutional 'rules of the game' that guide attitudes, behaviour and relationships in the PNG context and in the emerging health sector SWAp, and broader contextual factors.
The report contends that while PNG has a fundamentally sound national health policy, implementation has fallen short of the mark. Relying on a capacity development lens, the report explores some of the reasons why NDoH has been 'successful' in policy development, but less so in policy implementation. It suggests that PNG's policy development strengths are rooted in the experience and commitment of senior actors in the sector and are buttressed by a broad consensus in PNG on the importance of health services.
Shortcomings in implementation are attributed to a number of factors, some of which are internal to the sector, including management issues, relationships, financing arrangements, the skills of health practitioners, and external factors, such as the institutional rules which affect the behaviour of sector stakeholders. Despite the implementation challenges, the team noted a number of 'success stories' which
The report concludes by underlining the value of relying on a systems perspective on capacity development in PNG's health sector and thinking in terms of a complex 'capacity ecosystem'. It suggests that the system in PNG is a complex of competing and occasionally complementary policy objectives, institutional arrangements, relationships, incentive systems, and political interests, some of which support efforts to strengthen sector capacity and improve performance, and others which can undermine it. The study also points to the importance of Papua New Guinean culture, traditions and diversity as factors influencing organisational behaviour, stakeholder collaboration, and even the perceived legitimacy of the state.
Finally, the report suggests that capacity issues need be more at the forefront of deliberations in PNG on health reforms, not just as a series of technical constraints
to be 'solved', or gaps to be filled, but as a complex of issues - soft and hard - which need be dealt with in a complementary and systematic manner in order to address the development challenge of improved health for all Papua New Guineans. Doing
this, it is argued, will require a clear commitment to and shared appreciation of what capacity development entails, rooted in a broader partnership involving the National Department of Health, other government actors (including senior representatives of
central agencies), decentralised levels of government, civil society actors and donor partners.
Papua New Guinea's health sector: A review of capacity, changes and performance issues [PDF file - 786KB]
Available: Electronic version only
This report was commissioned by AusAID. The findings, interpretations and conclusions expressed in the report are those of the authors and do not necessarily reflect the views of AusAID or the Australian Government.
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