2018年-世界发展银行全球_Service_Delivery_by_Health_Facilities_in_Papua_New_Guinea_112页_1mb

Summary of Service Delivery by Health Facilities in Papua New Guinea

Core Content

This report provides an analysis of health service delivery in Papua New Guinea (PNG), based on a countrywide health facility survey. It outlines the current state of health facilities, challenges in service delivery, and recommendations for improving efficiency and equity in the health system.

Main Objectives

• To assess the inputs and outputs of health services.
• To evaluate the readiness and efficiency of health facilities.
• To identify key enablers for service delivery and areas requiring improvement.
• To support policy development for the National Health Plan (2011-2020).

Key Findings

1. Health System Overview

• PNG has made some progress in health indicators over the past 25 years, but the pace of improvement is slow.
• The country has not met Millennium Development Goal targets for maternal and under-five mortality.
• The health system is weak, especially in the delivery of frontline services.
• Public health spending is projected to decline, which could further weaken the system.

2. Health Facility Readiness

• The overall infrastructure condition of health facilities is poor.
• Most facilities require major building repairs, adequate toilets, stable electricity, and consistent water supply.
• Level 3 and 4 public facilities are less prepared than their church-run counterparts.
• The readiness index for level 3 and 4 public facilities is 40.3, while for church-run facilities it is 48.6.
• Level 5 to 6 facilities have a readiness index of 84.6, and level 7 facilities score 100.

3. Inputs and Outputs

• Infrastructure: Most facilities lack adequate infrastructure, with public level 3 and 4 facilities reporting the lowest scores.
• Medical Supplies: There is a significant shortage of basic drugs and supplies in lower-level facilities. The availability of vaccines is also limited, with BCG vaccine being the most scarce.
• Service Availability: Level 7 facilities offer the most comprehensive services, while lower-level public facilities lag behind.
• Human Resources: There is an acute shortage of doctors, especially in lower-level facilities. Nurses, CHWs, midwives, and kitchen staff make up the majority of the workforce.
• Workload and Satisfaction: Health workers report high workload, but are generally satisfied with their jobs. Satisfaction levels vary by cadre and facility type.
• Knowledge Index: Most health care providers, including fully trained doctors, scored poorly in the knowledge index, particularly in maternal and child health.

4. Management and Safety

• Leadership and governance are key factors in health service delivery.
• Safety-related indicators, such as medical waste disposal and cold-chain equipment for vaccines, are generally poor in lower-level facilities.
• There is a lack of cold-chain equipment in many facilities, affecting immunization programs.
• Medical waste disposal practices are inconsistent, with many facilities lacking appropriate systems.

5. Cost and Output

• The average cost of running a health facility varies by level and type.
• Level 7 facilities have the highest output, while lower-level public facilities have the lowest.
• User fees and other revenue sources are important for facility funding, but they are not sufficient to cover all costs.
• Budget and expenditure comparisons show significant disparities across facility types and levels.

6. Efficiency

• Bed occupancy rates and personnel-based performance measures indicate varying levels of efficiency.
• Lower-level public facilities are less efficient in terms of cost per unit output.
• The free-hand production frontier shows that many facilities operate below the efficiency frontier.

7. Policy Implications

• The report recommends improving the availability of essential medical supplies and infrastructure.
• Enhancing the capacity and motivation of health care providers is crucial.
• Strengthening the supply chain and procurement systems to ensure continuous drug availability.
• Increasing the number of trained personnel, especially doctors and specialist staff.
• Improving the management and governance of health facilities.
• Enhancing the efficiency of health service delivery through better resource allocation and utilization.

Key Information

• Facility Readiness: Poor in lower-level public facilities, better in church-run and higher-level facilities.
• Drug Availability: Low across all facility types, with antibiotics, analgesics, and antimalarials being the most in short supply.
• Human Resources: Shortage of doctors, especially in lower-level facilities. Female representation is low in leadership roles.
• Service Availability: Level 7 facilities provide the most services, while lower-level public facilities provide fewer.
• Efficiency: Lower-level public facilities are less efficient, with higher cost per unit output.
• External Financing: Declining, with Australia as the largest bilateral donor and the Global Fund and Gavi as important partners.
• Policy Recommendations: Focus on improving infrastructure, supply chain management, human resource development, and efficiency in health service delivery.

Figures and Tables

• Figure O.1: Infrastructural Indexes for Health Facilities Surveyed.
• Figure O.2: Comparison of Availability Indexes by Facility Type.
• Figure O.3: Comparison of Service Availability and Readiness Indexes by Health Facility Level and Type.
• Figure O.4: Distribution of Human Resource Cadres by Facility Level.
• Figure O.5: Average Weekly Hours Worked at Health Facility and Outreach by Facility Level.
• Table O.1: Percent of Budgeted Vacant Positions by Personnel Category.
• Table O.2: Total Number of Females in Each Personnel Category by Facility Type.

Conclusion

The health system in PNG faces significant challenges in service delivery, particularly in infrastructure, supply chain, and human resource management. Improving these areas is essential to meet the goals of the National Health Plan and ensure quality, accessible, and affordable health services for all, especially the poorer segments of the population. The report highlights the need for increased investment in human resources, better management practices, and enhanced efficiency in health service delivery.