Broken down health system

HEALTH secretary Dr Clement Malau’s powerpoint presentation to the PNG Media Council conference in Goroka last week started with the picture of a broken down car.
On the hood of the car were the words: “Current health system”.  He did not need to explain anything. The public health system PNG is driving is broken down, archaic and in need of total overhaul.
The statistics speak for themselves. Every six hours, a mother dies in child labour or from easily preventable diseases somewhere in this country. There are four less women a day or 1,300 women in a year.
Some 15,000 children die each year, Malau said. That means that a child dies every two hours. A third of those die from pneumonia.
Among Pacific Island nations, excluding developed Australia and New Zealand, PNG is the richest. Yet, it is far behind Fiji and even Melanesian neighbour the Solomon Islands. Out of 182 countries, PNG is placed 148. Fiji is placed 108 and Solomon Islands is 135.
It is small wonder that the health secretary likens the public health system to a car that has broken down, has chronic engine problem and needs a huge overhaul.
And, perhaps, it does not need an engine overhaul. Perhaps, it might be easier to buy a brand new car. This seems to be what the Health Department is aiming at with its new 2011-20 health plan.
It has adopted a whole of public health approach which involves every stakeholder from government to private health providers to churches and development partners with the catch cry: “Health is everybody’s business.” And, so it should be.
The plan proposes a national health authority. There must be one health plan, one team and one budget. After all, it is one health system.
Through a nationwide system of community health posts, the plan envisages a community health system where every facility will have access to trained health workers, medicine, immunisation, family planning and clean running water.
The new approach entails massive upgrading of skills and increasing the current work force. Malau gave the following figures:
• More doctors – from 376 to 489;
• More HEO – from 447 to 581;
• More nurses – from 3,356 to 4,363;
• More midwives – from 287 to 373; and
• More community health workers from 11,000 to 33,000.
This is a massive undertaking but not insurmountable over the 10-year life of the health plan.
The current cost of public health is not small.
Public expenditure on the health sector this year was K925 million, Malau said. Some significant costs sectors include the following:
*Rural health services – K312 million;
*Rural water supply – K22 million;
*General hospitals – K281 million;
*Population supplies – K20 million;
*Pre-service training –K16 million; and
*Central – K273 million.
Funds for these costs items are received from:
*Total PNG appropriations – K631 million (K80 million medical supplies); and
*Total DPs – K294 million (K55.7 million medical supplies).
If the above costs are thought to be big, the budget for the 2011-20 plan is a whooper. Total health sector expenditure proposed for the life of the plan is K14.170 billion.
These are to be divided, Malau said, into three intervention areas.
Summarised the intervention areas and their estimated costing are as follows:
Intervention area one – rural health services improvement
*Additional cost per year – K166 million; and
*Total additional cost over life of plan – K1.663  billion.
Intervention area two –  strategic hospital improvement.
*Additional costs per year – K120 million; and
*Total additional cost over life of the plan – K1.195 billion.
Intervention area three – other hospital improvement
*Additional costs per year – K206 million; and
*Total additional cost over life of the plan – K2.063 billion.
This might appear to be a huge estimate and it might make the budget planners cringe a little when faced with such a huge amount but if that is what it takes to put the country’s health on the right track, then so be it.