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Should Australia offer to take over Papua New Guinea’s failed health system?

By Jeffrey Wall - posted Friday, 3 September 2021


Readers may recall that some months ago I described the Papua New Guinea health system as a "failure". Since then the position would seem to have worsened significantly.

To my mind that raises a serious question both the Australian government, and hopefully the Papua New Guinea government, need to consider.

Given the truly tragic state of the PNG health and hospitals system today should the Australian government offer to effectively take over the system, rebuild and grow it, for a period of three years or so?

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I have been advocating Australia should offer to run the Angau Hospital in Lae, one that can help service the basic health needs of a significant proportion of the PNG population.

But I have come to the conclusion that just would not be sufficient, either to help protect the Australian national and strategic interest or the basic health welfare and stability of our closest neighbour.

In this contribution I want to outline just how critical the position is, and potentially how concerning it must be for the government and people of Australia, and especially Northern Australia.

This week a Devpolicy blog written by Stephen Howes and Kingtau Mambon chronicled just how alarming the position in one critical area – infant vaccinations – has become.

Based on World Bank data, Papua New Guinea now has the LOWEST vaccination rates in the world for vaccines for measles, diphtheria, whooping cough and tetanus, and hepatitis B! Lower than Somalia, lower than Syria, lower than Chad, lower than Haiti, and lower than South Sudan.

The vaccination rates for infants in Papua New Guinea are 37% for measles, 35% for diphtheria etc and 35% for hepatitis B. Put simply, that puts two thirds of the children of Papua New Guinea at risk from diseases than can be prevented with vaccination, diseas that cause serious illness and death.

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Given these alarming figures it will come as no surprise when I outline just how poorly Papua New Guinea is doing when it comes to vaccinating against Covid-19 despite that fact that Australia has generously provided large quantities of vaccines, as has the United States, New Zealand, and China.

In some developing countries, especially in Africa there is a critical shortage of vaccines. That is not the position in Papua New Guinea. Our closest neighbour has sadly had to discard some vaccines as their "use by" debate has expired.

Based on official statistics released irregularly by the PNG disease control centre, the vaccination rate seems to have basically stagnated at around 95,000. There has been little increase in the number of vaccinations in recent weeks. Testing has also slowed right down.

The population of Papua New Guinea is around 8 million – about the same as the population of New South Wales. The number of vaccinations administered in New South Wales as of yesterday was 6.5 million!

There are a number of reasons why the PNG vaccination rate is so low. There is long standing traditional/cultural opposition to vaccinations generally; but there is also a lack of basic health services to administer vaccinations; and there is a total lack of adequate health education campaigns to counter hesitancy driven by traditional opposition and more recently online anti-vaccination campaigns.

The troubling level of Covid-19 testing and vaccination is symptomatic of a "failed" health system.

But there is even more recent evidence to confirm just how critical the position has become.

A few weeks ago the Australian Minister for the Pacific proudly opened Australia's largest development assistance project in Papua New Guinea – a number of new wards at Angau Hospital in Lae built at a cost of $200 million.

But just last week, a senior Morobe Provincial Health official revealed the Angau Hospital has effectively been out of basic medicines and drugs for most of this year. Patients have been given prescriptions to take to pharmacies to buy their own vital drugs and medicines!

His claims have been supported by patients, and I have been told exactly the same position exists in other major hospitals across Papua New Guinea.

As I have written about previously, it is utterly tragic that the worst area of corruption in the PNG public sector is in the health and hospitals area. The Parliamentary Public Accounts Committee undertook an inquiry which confirmed the corruption, waste and abuse, but nothing seems to have changed.

What should Australia now offer to do about this appalling position, a position that if uncorrected will eventually threaten the Australian national interest as well?

I have long advocated Australia need to go "big and bold" in countering the China influence in PNG, and strengthening our government-to-government and people-to-people relationship.

But the state of the PNG health system, and the nation's hospitals, requires us to go well beyond countering the China influence. The crisis on our doorstep is really unrelated to China.

The PNG national health budget is around K1.7 billion a year. That is around $A700 million. Australia's "development assistance" support for Papua New Guinea is around $550 million a year.

This question arises in my mind – does Australia have the available funds, and skills capacity, to really make a difference. In other words, do we have the capacity to go "bigger and bolder"?

The answer on funding can clearly be "yes". Australia could weed out the corruption, waste and fraud in the health and hospitals system if given the mandate to do so. That means the additional cost above and beyond the existing PNG health budget would be manageable.

Given the state of Australia's public hospitals, and state health systems, "capacity" would be a challenge. But it can be met by harnessing the wonderful resources of Papua New Guinea's churches, which already deliver up to half the hospital services across Papua New Guinea. To that can be added NGOs such as Youth With a Mission (YWAM) with the capacity to do even more than they do already.

I have come to the conclusion the enormousness of the problem simply cannot be addressed by only "resourcing" the existing health bureaucracy and hospitals alone.

There has to be a "clean sweep" beginning with the cancellation of the widely criticised drugs and medicines supply system the Public Accounts Committee has been scrutinising. Australia until 2013 delivered most of the drugs and medicines the PNG health system needed, but when the PNG health department chose a non-Australian supplier, that ended – and the system has been a disaster ever since.

Then we must consider providing the maximum resources we can spare to run major hospitals, oversee the nation's thousands of health centres as much as possible AND work with the PNG Government to develop and implement a health education, and public assurance campaign, focussing on not just Covid-19 vaccinations, but also vital vaccinations for infants.

Now it might be argued that what I am proposing amounts to an effective takeover of the PNG health and hospitals system.

Well if we want to make a real difference, and help restore a "failed" system, and one that is failing even more, then an effective takeover, with the full agreement of the Papua New Guinea Government, might be the only solution.

Australia can make a compelling case given our historic association with Papua New Guinea, our enduring people-to-people relationship, and the fact we are easily the most generous aid contributor to our closest neighbour.

But surely the time will come when the very social harmony and cohesion of Papua New Guinea, and the impact that will have on Australia's security and strategic interest, requires Australia to be "bigger and bolder" to help Papua New Guinea rebuild a "failed" health system right on our northern border?

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About the Author

Jeffrey Wall CSM CBE is a Brisbane Political Consultant and has served as Advisor to the PNG Foreign Minister, Sir Rabbie Namaliu – Prime Minister 1988-1992 and Speaker 1994-1997.

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Creative Commons LicenseThis work is licensed under a Creative Commons License.

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