FREE healthcare could cripple Papua New Guinea’s health system, as patient fees are the only funding source for some of the country’s clinics, according to a report released by the Australian National University (ANU).

Released by the ANU’s Development Policy Centre, the report – A Lost Decade? Service Delivery and Reforms in PNG 2002-2012 – found the availability of medicines in the country had fallen between the study periods, with the supply of six basic drugs dropping from 82 per cent availability to 74%.

A report investigating PNG’s progress on health and education in the context of the country’s economic boom has found that 29 per cent of PNG’s clinics relied solely on user fees to cover operating costs, and the majority of health centres were struggling to provide even the most basic services.

The results for education showed more promise, though it was clear the country was struggling to cope with the surge in enrolments on the back of the country’s population boom.

“If we look at PNG’s primary health care system today we see a system struggling against the odds, and unable to fulfil basic functions,” the report said.

Only a fifth of clinics had beds with mattresses, only 40% had access to electricity, and just over half had a year-round water supply.

“The recent decision to abolish health user fees will likely lead to further deterioration of primary health care,” the report said.

“It will be very difficult, if not impossible, to compensate clinics for the abolition of fees

“While the intention of the policy is to improve access to services, its implementation will likely weaken, rather than strengthen, the health system.

“If the government wants to improve primary health care, it will have to fund it better.”

The Report found the availability of medicines in the country had fallen between the study periods, with the supply of six basic drugs dropping from 82% availability to 74%.

The number of patients who visited a health clinic on a typical day fell by about a quarter.

“This is particularly worrying given rapid population growth and since the number of health clinics in PNG has been falling,” the report said.

Three-quarters of health workers reported spending some of their private income on supplies and services for the clinic, while retired health workers reported regularly continuing to work in the sector as volunteers.

Though the number of health workers per clinic increased, the number who turned up for work was unchanged at 4.1 per clinic.

“The number actually present at the time of the survey fell from 3.4 to 3.2,” the report said.

Clinics themselves are said to be “in a state of disrepair”, with 67 per cent of those surveyed requiring maintenance in 2012.

Just 41% of clinics had refrigeration, 23% had a kitchen, 30% had access to fuel, and only 33% could transfer patients.

The study found oversight to be weak, with only 40% of clinics receiving a visit from an administrative supervisor in 2012.

“The deteriorating performance of PNG’s primary health care sector is linked to weak finances,” the report said.

“Despite large increases in health function grants to provinces to fund operational costs for health clinics, 41 per cent of clinics reported receiving no external financial support in 2012.”

There was significant variation across provinces, with East New Britain standing out as a top performer, having the most patrols, and highest maintenance levels and highest proportion of positions filled.

“The primary health care system is in such a dire state that a sequenced approach is needed for its repair: the first priority should be to get the bigger district-level health facilities working,” it said.

The report’s authors noted that there was a need for the country to learn from the better-performing provinces.

“The first challenge is to get more external support to health clinics, so that they become viable centres of support rather than ghost clinics unable to deliver even basic services,” the report said.

“This will require greater budget allocations, but also new ways to get funds to clinics.”

The report noted the possibility that funding in lieu of private fees could be sent directly to clinics’ bank accounts from the government to limit the risk of “diversion”.

“As long as funds pass through provincial governments, there is a real risk of diversion,” the report said.

“This transmittal of funds directly from the national government to health clinics, or at least health centres, should also be considered.

“What is clear at this stage is that there needs to be a shift to ensure that greater funding reaches clinics, putting f lexible resources at their disposal.”

There was also a need to address health workforce concerns around pay disputes and an ageing workforce.

Mixed results in education

The report found PNG’s primary schools had expanded rapidly in the 10 years to 2012, but while enrolments had increased by 85% since 2002, attendance figures had fallen.

The percentage of grade 5 students at school on the day of the survey fell from 84% to 71% in the 10 years to 2012.

“While the rising level of absenteeism is a problem, there are still many more students in school today than ten years ago,” the report said.

Staffing numbers increased over the period but it was not enough to cope with the huge increase in enrolments as a result of the population boom.

“The average school had 6.5 teachers working in 2002 but 8.7 in 2012, an increase of one-third,” the report said.

The rapid enrolment growth, however, had caused the student-to-teacher ratio to rise from 31-1 to 36-1 over the decade.

The report noted that while there had been general improvements in school infrastructure, facilities “remained far from satisfactory”.

Access to drinking water at schools increased from 58 to 72%, those with electricity rose from 15%to 27%, while those with satisfactory female toilets increased from 56% to 61%

The size of schools increased by a classroom-and-a-half over the period, with the average school having 8.4 classrooms by 2012.

“The improvement in school indicators reflects better funding over the decade,” the report said.

“After adjusting for inflation, average school revenue increased by 150% from 2001 to 2012 to reach K87,500.

Major progress was made in girls’ education, with enrolment figures for females increasing by 144% on 2002 figures.

But attention should be paid to lifting attendance relative to enrolment, with more teachers hired to reduce class sizes.

“PNG’s schools have expanded greatly over the last decade, but now need to focus on quality,” it said.

“One of the key findings of this report is that the more effort teachers put into teaching the more likely communities are to send their children to school.”