Rural Health in Papua New Guinea

Matthew Zebby

Prior to independence the PNG public health system was centralised and aimed at district levels. The result was efficient delivery of health services to the rural areas. After independence the introduction of decentralization resulted in rapid deterioration mainly due to poor management and lack of proper control by provincial health offices. The new organic law on provincial and local governments was introduced in 1995 to revive rural health services.

At present five major points can be derived from observation:

• There is no improvement in health, particularly in the rural population. 15000 babies<1yr die annually, 13000 babies die before reaching 5yrs, 220000 of a possible 560000 children under 5yrs are undernourished, and 3700 mothers die annually of birth complications.
• Limited resources have reduced the health budget affecting implementation
• Mismanagement of resources at all levels
• Difficulty accessing health services. 50% of the children are not immunized.
• 60% of mothers undergo childbirth without proper supervision. Numerous aid posts have been shut down. 30% of the rural community have access to safe drinking water. With 55% of the people illiterate plus a diversity of languages, the spread of health messages is a complex task.

The rural health staffs, primarily community health workers, endure a lot of hardships including isolation from basic services such as clean water and electricity. The terrain, swamplands and poor road maintenance make access to basic services difficult. A good number of workers live in makeshift huts.

A deficiency in communication equipment in rural health centres makes contacting doctors in main centres impossible during emergencies. Patients, most times, have to be carried long distances to the nearest road and rushed to the hospital before it is too late.

Although faced with such challenges daily the rural health worker remains dedicated to his or her work.

Rural health care refers to patient management at aid posts, health centres, clinics and rural hospitals. Patients with serious conditions are referred to the major hospitals. Widely distributed standard treatment manuals are supported by visits from doctors in major hospitals.

The uneven distribution of health services has been compounded with the closing down of 22% of aid posts and scaling down of health services in rural areas.

The necessary steps that need to be taken are:

• The introduction of minimum standards for district health systems
• Better supervision training and patient referrals
• Better medical supplies and equipment
• Efficient logistics and communications
• Reviving community involvement and skills, and public awareness.

These are current priorities of the health department starting with the reopening of aid posts and the extension of health services.

To conclude, government policies in the past have not had the desired effect on health services. The current health policies are vital and will significantly lift rural health care in Papua New Guinea if they are maximally implemented.