Global Integrity, in close collaboration with the Australian Agency for International Development (AusAID) and the Consultative Implementation and Monitoring Council (CIMC) in Papua New Guinea (PNG), has recently completed an indicator-based expert assessment of access-to-information in health care service delivery in PNG. The objective of the pilot assessment is to identify access-to-information issues that have been theorized to play an important role in determining whether service delivery beneficiaries are empowered (or not) to demand improved services in health care at the provincial level in PNG and to hold providers accountable for their performance. The preliminary results of this assessment suggest that it is premature to conclude whether and why citizen access to and use of information can hold providers accountable (complementary analytic tools need to be mobilized to obtain a more conclusive sense). Nevertheless, we argue that our data do provide a window into what information gaps exist. As such, this pilot study can potentially serve as a diagnostic tool for identifying and cataloguing informational lacunae.
The health sector in PNG faces several problems, including high infant and maternal mortality rates, infectious diseases (including tuberculosis and HIV), and acute shortage of resources such as essential drugs. The challenges associated with poor physical access and infrastructure make service delivery expensive and out-of-reach to many citizens, especially rural populations. These problems are compounded by a decentralized and fragmented health care system that has led to a lack of coordination and oversight of responsibilities between national and provincial/district government agencies, hospitals, health clinics, civil society organizations (CSOs), and budget institutions. The passage of the Organic Law in 1994-95 attenuated the central government’s ability to implement national policies by making provinces responsible for handling primary health care services. However, the management of hospitals, pharmaceutical purchases, and oversight remains the responsibility of the (weak) national government. From this, a cumbersome bureaucracy was born (or exacerbated).
Some of our preliminary findings include:
• The national capital of Port Moresby earned the lowest overall rating of all the provinces assessed in the study;
• The strongest performing category across all the provinces was the legal framework on the availability, accessibility, and usability of information on health care, as well as the existence of information on quality of performance;
• The lowest rated category was the level of information around citizen participation in the decision-making process of health care service delivery.
You can find the complete report, including a more fulsome description of our methodology, here.
— Raymond June