2015年-世界发展银行全球_Financing_the_Frontline_in_Papua_New_Guinea___An_Analytical_Review_of_Provincial_Administrations_Rural_Health_Expenditure_2006-2012_54页_1mb

Summary of "Financing the Frontline in Papua New Guinea: An Analytical Review of Provincial Administrations' Rural Health Expenditure 2006-2012"

Core Content

This document, Financing the Frontline, is a follow-up to the 2013 report Below the Glass Floor, which examined the performance of rural health service delivery in Papua New Guinea (PNG) from 2006 to 2010. It updates the analysis to cover the years 2011 and 2012, focusing on how provincial administrations finance and deliver frontline health services in rural areas. The study combines expenditure data, performance metrics from the National Health Information System (NHIS), and findings from the Promoting Effective Public Expenditure (PEPE) facility surveys to provide a comprehensive understanding of the financial and operational dynamics of rural health services.

Main Findings

National Level Support for Frontline Services (2011–2012)

• The national level is crucial in enabling the delivery of rural health services by ensuring timely and predictable transfers of funds to the provincial level.
• Cash disbursement from Port Moresby to provinces remained variable, with 17 out of 18 provinces receiving 50% of their appropriations by February 2011, but no funds were transferred in January or February 2012.
• Certainty in cash release is essential for improved service delivery, but a standard schedule has not been implemented.
• The Provincial Health Authority (PHA) model has introduced new responsibilities and blurred lines between government and non-government actors (e.g., churches).
• There is a need to clarify functional responsibilities across all levels of government and non-government entities to avoid service gaps and enhance accountability.

Provincial Support for Frontline Services

• Table 1 provides a profile of provincial spending relative to cost estimates for frontline rural health activities.
• Seven provinces, representing 35% of the population, spent less than a third of what is estimated to be necessary for frontline health services.
• Manus and Gulf provinces had the highest spending relative to cost, with 70% of required funding.
• New Ireland and Western Highlands had relatively high fiscal capacity but spent less than required.
• Milne Bay Province had unconfirmed spending due to the large amount transferred to the PHA without separate reporting.

Provincial Spending on Frontline Activities (2011–2012)

• Facility operations and outreach patrols saw more budgeted and spent funds compared to other activities.
• Drug and medical supply distribution showed notable improvement, but responsibility ambiguity persists.
• Patient transfer had small signs of increased spending, particularly in Morobe Province, but overall remains underfunded.
• Clean water provision and supervision continued to show minimal spending, indicating these are not well-prioritized.

Key Issues

• Ambiguity in roles and responsibilities between the national and provincial levels, and between government and non-government actors like churches.
• Unreliable funding transfers from the national level to the provincial level, affecting the timeliness and predictability of service delivery.
• Low spending on critical activities such as patient transfer, clean water, and supervision.
• Lack of clarity in funding allocation and insufficient monitoring and reporting systems at the provincial level.
• Operational grants to church-run facilities are not included in the analysis, as they are not part of the provincial accounting system (PGAS).

Policy Recommendations and Next Steps

1. Clarify Responsibility: Establish a working group to review and define the roles and responsibilities of all stakeholders in rural health delivery.
2. Improve Funding Timeliness: Develop and implement a standard cash release schedule to ensure timely and predictable transfers to frontline services.
3. Sustainable Facility Maintenance: Explore sustainable models for maintaining rural health facilities, aligning funding with these needs.
4. Align Funding with Performance: Use facility-based budgeting and performance data to better align funding with actual service delivery requirements.
5. Address Fiscal Gaps: Ensure that provinces with higher own-sourced revenue (e.g., from GST and royalties) prioritize and fund rural health appropriately.
6. Enhance Monitoring and Reporting: Strengthen systems for collecting and analyzing expenditure and performance data to improve transparency and accountability.
7. Integrate Findings: Combine expenditure data, NHIS performance metrics, and PEPE survey results to inform and shape future policies and strategies.

Conclusion

The study highlights the need for better financial management and clearer responsibilities in the delivery of rural health services in PNG. While some progress has been made in certain areas, such as facility operations and outreach, many critical activities remain underfunded. The integration of multiple data sources provides a richer understanding of the challenges and opportunities, supporting more effective policy development and implementation.