Inez Mikkelsen-Lopez and Alan Cairns explain that better information and a willingness to tackle difficult issues are necessary to ensure a fit-for-purpose and accountable health system in Papua New Guinea
Despite spending more on the health sector, some of the country’s key health indicators lag behind others in the region. There is no clear correlation between the investment made and better health outcomes. Improvements in life expectancy in Papua New Guinea have been slower over the past decade compared to the rest of the world and are still the lowest in the Pacific region. Infant, under-five, and maternal mortality rates are higher than in countries at similar income levels, and utilisation of basic health services has declined markedly.
Misaligned incentives (not always the result of bad intentions but a response to resource constraints), have created gaps in health service delivery, creating a dysfunctional health system and increasing mistrust and frustration from the patients when health services are not available.
The question posed about value for money in health spending is not a new one, nor is this question unique to Papua New Guinea. Globally, countries of all income levels grapple with the need to spend better, not necessarily more, so as to create better value for patients and the health sector. This includes questions on efficiency, improving health outcomes with existing resources and addressing inequities in service access. The common issue is the need to ensure that health resourcing is well-directed and that the right amount is available at the right place and at the right time to support the delivery of basic health services.
Information is one of the key ingredients in efficient delivery of health services. Health officials require accurate, timely and integrated information to oversee strategies and service delivery plans, and systematically measure progress against them. The information
required to operate a country health service is complex, with data collected from a vast network both within the health sector and outside. The accounting system, human resource and payroll systems, health (statistical) information system and pharmaceutical management system all collect and maintain the information that managers require to maintain line-of-sight between the resources they use and the services they deliver. Without this information, health managers are effectively managing with one hand tied behind their backs.
In Papua New Guinea, progress is being made in developing and improving these critical information systems, but much more is required. At the sub-national level where services are actually delivered and managed – legacy systems based on basic word processing tools are still used to record finance and human resources; and information on payroll and pharmaceutical management is centrally administered and not readily available to health managers. Yet at the same time progress is being made in one of the harder areas – in the collection and reporting of statistical health information from the country’s vast network of rural facilities.
In Papua New Guinea, the health sector is adopting elements of informatics to facilitate the collection of data through the electronic National Health Information System.
The system collects service delivery data at the facility level and makes it available – in a timely way – to health managers at the district, provincial and national levels to inform better decision-making. The system also creates alerts for health workers and includes training components to improve clinical governance in health workers. Creating this two way information exchange is a significant achievement in Papua New Guinea, a country with a vast topography, and at 87% the rural share of population is the second highest globally.
Yet, critical, better information systems alone will not translate spending into improved health sector performance in Papua New Guinea. There are significant architectural matters within the government system that need to be addressed to promote the timely disbursement of funds to support frontline facilities. Getting the right amount of funding to the right place at the right time to finance payroll and operational costs remains a major challenge. Establishing a funding flow that is both adequate and reliable will greatly enhance service delivery and promote accountability.
FROM A VAST
A combination of factors, including – a complex and evolving form of decentralisation; and regular economic volatility caused by economic shocks and unforeseeable natural events – and misaligned incentives all present as regular impediments in improving the adequacy and certainty of funding flows. Resolving these impediments will require close cooperation between the health sector and the central agencies that manage the country’s systems of government administration.
The ADB report suggests aligning stakeholders as these challenges cannot be resolved or overcome by the health sector alone. They require a coalition of the willing.
As the health sector works more closely with central agencies to improve planning and budgeting, as the barriers to funding pathways are removed, and as resourcing and funding are increasingly allocated to best meet patient demand and promote value in health services, the focus will naturally move to monitoring and accountability. Improving information system and training in its use including change management will become co-investments. As the sector establishes good information systems that facilitate the transfer of timely information, health managers at all levels and other interested parties will be able to monitor progress and make the strategic decisions necessary to drive improvement toward better health outcomes. If we look at Papua New Guinea’s health performance, we might consider that the health system is lost but there is a path to finding it.
This article was originally published on the Asian Development Blog and is based on the ADB report ‘Line of Sight: How Improved Information, Transparency, and Accountability Would Promote the Adequate Resourcing of Health Facilities Across Papua New Guinea’.