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What is the issue ?

Strengthening Church and Government Partnerships for Primary Health Care Delivery in Papua New Guinea: Lessons from the International Experience HPHF Hub Technical Review Meeting Judith Ascroft : Monday 10 October 2011. What is the issue ?.

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What is the issue ?

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  1. Strengthening Church and Government Partnerships for Primary Health Care Delivery in Papua New Guinea: Lessons from the International Experience HPHF Hub Technical Review Meeting Judith Ascroft : Monday 10 October 2011

  2. What is the issue ? • CHS providers manage up to 50% of rural and remote facilities in Papua New Guinea • 6 of 9 nurse training facilities • 14 training facilities for community health workers • The relationship between church health service providers and government in PNG has been described as ‘weak’ • No formal agreement in place • Research aimed to understand differences in service provision, the nature of the engagement and opportunities to strengthen the relationship

  3. Research Questions • What makes primary health care service provision by church based organisations different to government health service provision? • What are the characteristics of existing arrangements for governments to engage non-government, non-profit providers of primary health care services?

  4. Background and Context • PHC facilities are the predominant point of access to the health system for 87% of the population in PNG • Infectious diseases and maternal and child health greatest burden • Health system decentralised and fragmented • Disconnect between programs, priorities, service providers and levels of govt • PHC service provision has deteriorated • Minister “Our health indicators have not improved over the past 10 years” • MMR – 733 per 100,000 live births • Government grants make up to 70-100% of total funding to CHS • Many attempts to develop MOUs, MoAs, and CHS Act to provide a legal framework for an agreement

  5. Approach/Methodology • Research questions identified through working group meetings – Knowledge Hubs, AusAID, NDoH, CMC • Literature Review training for research partners at Divine Word University (plus NDoH) • An empirical study based on a literature review of international peer reviewed and grey literature • Search strategy broad enough to identify evidence relevant to one or both research questions • Focus PHC in developing countries and relationships between not-for-profit health service providers

  6. Limitations • Predominantly descriptive case studies and program evaluations • Studies selected on the basis of relevance to research questions but no quality assessment • Key themes were identified for each research question but no detailed description or critique of each paper • Little evidence specifically identifying differences –demonstrated through discussions of strengths and weaknesses of CHS or Govt • Cannot draw a broad conclusion that CHS are better or worse in a given situation

  7. Overall Findings • A range of challenges in effective stewardship of mixed systems in countries such as Papua New Guinea • Examples of strong collaboration but also strains on CHS in some African countries • Critical factors: • high level support from MoH; • willingness of CHS providers to fully support implementation of NHP and policies; • strong, trusting partnership working for the benefit of the overall health system; • an enabling environment in which the partnership can flourish

  8. Key Findings • Issues with the health system ‘building blocks’ of leadership and governance, financing, health workforce, and service delivery eg: • CHS can be isolated from national policy and planning • Reluctance to adopt national policies eg related to family planning • A lack of transparency and consistency in financing of CHS • ‘Competition’ for human resources, salary differences, restrictive hiring practices • Differences in culture and management styles that can impact on ‘trust’

  9. Key Findings (contd) • Complex relationship between faith and health -influences both health seeking behaviour and health service provision • Relational contracts have been used to build trust and reduce costs of managing and monitoring ‘classical’ contracts • Important to create conducive conditions for successful contracting – legal framework, discourage corruption, capabilities to use programmatic, administrative and financial data, functional HIS • ‘Incomplete’ decentralistion and poor communications can impact negatively on partnership

  10. Factors which can be built on to enhance the partnership in PNG • PNG has a number of strategies, structures, policies and systems in place • Framework of new NHP 2011-2020 • Provincial Health Authorities Act 2007 • Recognising CHS as NFP public sector partners • Responding to local contexts within the framework of national policies • Assured funding commitments (Govt) and improved transparency (CHS) • Involvement in policy, planning and implementation of agreed standards • Utilising the strengths of CHS in training • Acknowledging and managing differences in culture and style • Accessing support from development partners to enhance the partnership

  11. Thank you • Questions?

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