Researchers say the “dire state” of Papua New Guinea’s primary health system will likely only get worse under the country’s free healthcare policy, as many clinics do not receive government subsidies and depend entirely on patient fees to survive.
A report launched on Thursday found that despite Papua New Guinea’s economic boom, health clinics are providing fewer services, and there has been a mixed result in the improvement of the country’s education.
The 2012 survey of 142 health posts found clinics were seeing 19 per cent fewer patients and had 10 per cent less medicine available compared with similar research conducted ten years earlier in 2002.
This does not allow for the significant increase in Papua New Guinea’s population over that decade.
The report, A Lost Decade: Service Delivery and Reforms in Papua New Guinea 2002-2012, launched in Port Moresby by Papua New Guinea’s National Research Institute and the Australian National University’s Development Policy Centre.
The report paints a bleak picture of the health services available in Papua New Guinea, stating only 20 per cent of clinics had beds with mattresses, about half had year-round access to water, and 75 per cent of health workers said they contributed to the cost of healthcare from their own pocket.
Free primary health care
In February the Papua New Guinea Government made primary healthcare free but researchers said that could make the situation even worse.
“The recent decision to abolish health user fees will likely lead to further deterioration of primary healthcare,” the report said.
User fees were the only source of funds for 29 per cent of health clinics surveyed.
“Now the Government said they’re going to subsidise clinics for the removal of user fees but the problem is there’s no real mechanism – most of these facilities don’t have bank accounts,” Stephen Howes, one of the authors of the report and an Australian National University academic.
But the office of Papua New Guinea prime minister Peter O’Neill stressed the report covered the decade before free education and universal healthcare were fully introduced and “so is not entirely relevant to the current situation”.
“There is no doubt that healthcare and education had been neglected in recent decades and reform was a priority set by prime minister O’Neill when he was elected in 2012,” a spokesman for Mr O’Neill said.
“The people of this nation know that we are seeing dramatic improvements in the delivery of essential services.
“This does take time but the delivery of healthcare and education today is in a much better state than decades past and will only continue to improve.”
Education results mixed
The research also looked into 216 primary schools and found mixed results in the education sector.
Enrolment had increased significantly, with the average primary school educating 58 per cent more students in 2012 compared with 2002.
Encouragingly for a country with woeful gender inequity, there were 148 per cent more girls enrolled in primary schools and the number of female head teachers had more than doubled over the decade.
The report found schools generally had more textbooks and better quality classrooms and teacher accommodation.
But with only 22 per cent more teachers and 21 per cent more classrooms, overcrowding was a major problem.
“You certainly see some worrying signs… Gulf Province, grade three, 80 students per average in a class,” Stephen Howes said.
The Papua New Guinea Government introduced fee-free tuition for primary schools in 2012.
Reform will take time: prime minister
Prime minister Peter O’Neill defended the abolition of school and healthcare fees.
“It was important to get more children in school and people access to a doctor in the short term,” Mr O’Neill’s spokesman said.
“New teachers and healthcare professionals are in training and entering the workforce, but turning around neglect of the past takes time and will not be achieved overnight,” he said.
The report praised the role of Boards of Management in overseeing schools and accounting for spending, saying health facilities should adopt similar systems.
“The primary health care system is in such a dire state that a sequenced approach is needed to its repair – the first priority should be to get the bigger district-level health facilities working,” the report said.
It also recommended a renewed focus on getting government funds to the “frontline” of health and education services, and the expansion of church-run schools and health clinics, which it found to be providing better services than government-run facilities.