2014年-世界发展银行全球_Assessment_of_Health_Financing_Options___Papua_New_Guinea_61页_1mb

Summary of the Assessment of Health Financing Options — Papua New Guinea

Core Content

This report, prepared by the World Bank in August 2014, evaluates three broad health financing options for Papua New Guinea (PNG): increasing general revenue spending, introducing Social Health Insurance (SHI), and mobilizing resources through efficiency savings. The goal is to support the Government of PNG (GoPNG) and development partners in making informed decisions about the most sustainable and effective health financing mechanisms.

The current health system in PNG is characterized by low health inputs per capita, low health service contact rates, and significant inequities in health care use and outcomes. Despite a high share of government spending on health, the system is inefficient and fragmented, with limited administrative capacity and high reliance on external donors. Health outcomes have remained stagnant over the past quarter century, and PNG is not on track to meet any of the health-related Millennium Development Goals (MDGs).

The report emphasizes that while external resources constitute a large portion of total health spending, sustainable financing requires improving the efficiency and coordination of the existing system. It also highlights that SHI is not currently feasible or sustainable, due to the high proportion of the informal sector, lack of administrative and technical capacity, and limited regulatory support.

The medium-term outlook for PNG is influenced by the LNG industry expansion, which could increase government revenues. However, the Government's revenue as a share of GDP is expected to decline, limiting the fiscal space for health in the short to medium term. Thus, the report suggests that increasing general revenue financing is unlikely to be a viable option in the near future.

Main Views

1. Health Financing Options

• General Revenue Financing:

  • Increasing general revenue spending is a key option, but the scope for growth is limited in the short to medium term.
  • The GoPNG's health spending as a share of GDP is expected to remain flat, while government revenue as a share of GDP is projected to fall.
  • Without improvements in efficiency and equity, increasing public spending may not lead to improved health outcomes.

• Social Health Insurance (SHI):

  • SHI is not feasible or sustainable in the current context.
  • The informal sector, which accounts for over 67% of the population, poses a challenge for SHI implementation.
  • Administrative and technical capacity for SHI is limited, and while political commitment has been renewed (Alotau Accord), regulatory and institutional support remains inadequate.

• Private and Community-Based Insurance:

  • Private health insurance is not well developed in PNG.
  • Community-based health insurance (CBHI) has limited potential due to low formal employment and administrative challenges.

• Efficiency Savings:

  • The most feasible and sustainable option is to mobilize resources through efficiency gains.
  • Key strategies include:
    • Allocating more resources to primary care than tertiary care.
    • Improving input mix and productivity.
    • Leveraging vertical programs (e.g., HIV and AIDS) to strengthen service delivery.
    • Continuing procurement reforms.
    • Improving planning and budgeting.
    • Utilizing alternative financing modalities such as direct facility funding (DFF) and provincial health authorities (PHAs).

2. Health System Overview

• PNG has a fragmented and under-resourced health system.
• Health infrastructure and staffing are inadequate, with low doctor and nurse availability per 1,000 population.
• Health outcomes such as infant mortality rate (IMR) and maternal mortality rate (MMR) are high, especially in certain regions.
• Inequalities exist in health care access and outcomes across provinces and regions.
• User fees have been removed in some areas, but out-of-pocket (OOP) spending remains minimal.

3. Data and Analysis Tools

• The report uses data from the 2009-2010 Household Income and Expenditure Survey (HIES) and the 2013 Sector Performance Annual Review (SPAR).
• BOOST (a World Bank analytical tool) is introduced as a method to improve public expenditure efficiency and identify inefficiencies.
• BOOST helps in analyzing budget allocations vs. actual spending, identifying where agencies are underspending or overspending, and improving resource allocation and decision-making.

Key Information

• Health Inputs:

  • PNG has significantly lower per capita health inputs compared to other Pacific Island countries.
  • The health workforce (doctors and nurses) is particularly scarce, with PNG having the lowest ratios in the region.

• Health Outcomes:

  • IMR and MMR remain high, with regional disparities.
  • The IMR in West Sepik is 105 per 1,000 live births, while it is as low as 22 in the National Capital District (NCD).

• Fiscal Space:

  • The GoPNG's health spending as a share of GDP is likely to remain flat.
  • Government revenue as a share of GDP is expected to fall, limiting the fiscal space for health.
  • The LNG industry and other extractive projects may improve fiscal space in the medium to long term.

• Efficiency and Equity:

  • The report emphasizes that efficiency improvements are critical for financial sustainability and equitable access.
  • The Function Grants (HFG) system is seen as a potential tool to improve the distribution of health inputs.

• Donor Dependency:

  • External resources (donors and international aid) constitute a large share of total health spending.
  • The report highlights the need to improve coordination and utilize donor resources more effectively.

• Recommendations:

  • Prioritize efficiency gains over increasing general revenue.
  • Improve planning and budgeting to reduce fragmentation.
  • Enhance geographical targeting of health programs, especially in "hotspots".
  • Avoid SHI in the short to medium term due to structural and administrative challenges.
  • Focus on strengthening existing systems and improving the coordination of external resources.

Conclusion

PNG's health system requires significant investment to improve outcomes and address inequities and inefficiencies. However, the current fiscal space is limited, and SHI is not viable in the short to medium term. The most feasible and sustainable option is to mobilize resources through efficiency savings. This includes improving primary care, procurement, and planning and budgeting. The report concludes that increasing public health spending will only be effective if inefficiencies in management and delivery are first addressed.