2017年-世界发展银行全球_Health_Financing_System_Assessment___Papua_New_Guinea_66页_3mb

Health Financing System Assessment of Papua New Guinea

Core Content

This document provides a comprehensive analysis of the health financing system in Papua New Guinea (PNG), focusing on its financial and institutional sustainability. It is part of a series of assessments in the East Asia and Pacific (EAP) region, including Indonesia, the Solomon Islands, Kiribati, and Vanuatu. The assessment is conducted at a critical time as PNG prepares to graduate from development partner (DP) support in key areas, highlighting the need for strategic planning and capacity building to ensure continued health program sustainability.

Main Viewpoints

1. Economic Context

• PNG has experienced significant economic growth from 2002 to 2014, averaging around 5.7% per year, but growth has since slowed due to global commodity price declines, domestic droughts, and weak nonresource sector growth.
• Despite economic growth, PNG remains a lower-middle-income country with a GDP per capita of US$2,688 (2016) and a national poverty rate of 39.9% (2009-10).
• The country has faced fiscal challenges, including a growing budget deficit and limited fiscal space, which threatens the health sector's ability to sustain programs.

2. Health System Overview

• The health system is fragmented, with unclear roles and responsibilities among various agencies and institutions.
• Access to health services is uneven, particularly between rural and urban areas, and many indicators have stagnated or declined in recent years.
• The quality of care and out-of-pocket (OOP) payments, even though not catastrophic, remain barriers to health access.

3. Disease Burden

• PNG faces a high burden of communicable diseases, noncommunicable diseases (NCDs), and injuries.
• Maternal and child health outcomes remain poor, with high infant and maternal mortality rates (IMR and MMR) for a country of its development status.
• Immunization rates are low, and the country is not on track to meet the Sustainable Development Goals (SDGs).

4. Health Workforce

• There is a significant shortage of health workers, with a ratio of 15.4 per 10,000 population (2016).
• The existing workforce is aging and unevenly distributed, with a strong preference for urban areas.
• Limited progress in health training and medical capacity exacerbates the shortage of qualified personnel.

5. Health Expenditure Trends

• Total Health Expenditure (THE) as a percentage of GDP is primarily government-funded, with low OOP spending.
• THE per capita has been declining since 2004, partly due to population growth offsetting the absolute increase in spending.
• The share of health spending in general government expenditure fell from over 9% in 2010 to 6.8% in 2014.

6. Donor Financing

• On average, 20% of total health spending comes from DPs, with funding levels, sources, and recipients being volatile.
• Australia is the largest bilateral donor, while GFATM and Gavi have become increasingly important partners in health service delivery.
• Donor-funded programs are increasingly implemented through NGOs and civil society organizations.
• As PNG transitions from donor support, the government must demonstrate its ability to manage cofinancing commitments and maintain critical health programs.

7. Financial and Institutional Sustainability

• Financial sustainability is threatened by the increasing reliance on GFATM and the transition from Gavi support.
• The government has not yet costed and appropriated the necessary funding for Gavi transition, nor integrated donor-funded activities into the national budget.
• Institutional sustainability is also challenged by the separate systems and human resources used by Gavi and GFATM, leading to inefficiencies in health staffing and service delivery.
• The government needs to improve coordination and integration of health programs to ensure long-term success.

Key Information

• Key Programs: The assessment focuses on the HIV and AIDS response, tuberculosis (TB), malaria treatment, and immunization programs, which have been largely supported by DPs.
• Health Financing Mix: The majority of health financing comes from government sources, with external funding playing a crucial role.
• Financial Challenges: The government is struggling with fiscal constraints, including budget deficits and limited fiscal space, which could impact health financing.
• Policy Priorities: The government must prepare for the transition from donor support, improve financial and institutional capacities, and ensure efficient use of resources.
• Health Policies: PNG has introduced Fee Free Primary Health Care and Subsidized Secondary Care, aiming to improve financial protection for vulnerable populations.
• Data Challenges: There are significant issues with data accessibility, comprehensiveness, and quality, which hinder effective planning and monitoring.

Policy Recommendations

• Prepare for Donor Transition: The government should abandon current donor support and integrate key components into the national budget. This includes strategic planning for future transitions and graduation from donor assistance.
• Manage Gavi Transition: Clarify the types and levels of interventions from major disease programs to be integrated into the health system. These activities need to be linked to provincial health authority (PHA) implementation and integrated into provincial service plans.
• Increase Health System Efficiency: Improve the efficiency of current health spending to increase fiscal space. This includes systematic documentation of budget, expenditure, personnel, and utilization data to track outcomes and reduce cost pressures.
• Strengthen Fiscal Analysis and Public Financial Management (PFM): Enhance the PFM system within the National Department of Health (NDoH) to allow donors to increase on-system support. Short-term funding needs and cofinancing requirements should be included in the Medium-term Expenditure Framework (MTEF).
• Improve Timely Release of Warrants: Ensure timely disbursement of operational funds to hospitals and Christian Health Services (CHS) to avoid bottlenecks in service delivery.
• Protect Government Financing for Frontlines: Ensure reliable release of Health Function Grant (HFG) and Free Healthcare Policy funding to eliminate user fees and support facility operations.
• Enhance Data Accessibility and Quality: Improve data sources for domestic and external funding, disease burdens, health access, and infrastructure to support effective planning and monitoring.
• Strengthen Reporting and Information Sharing: Increase engagement with the Ministerial Economic Committee and Provincial and Local Level Service Monitoring Authority (PLLSMA) to improve communication and reporting on health strategy implementation challenges.

Conclusion

The HFSA underscores the critical need for PNG to improve its financial and institutional sustainability in the health sector. With the country moving toward universal health coverage (UHC) and preparing to graduate from donor support, the assessment highlights the importance of strategic planning, efficient resource use, and stronger governance and management systems to ensure continued progress in health outcomes.