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TRANSCRIPT
Promoting Effective Public Expenditure Project
PNG’s Lost Decade?
Preliminary Health Survey Findings
Provincial comparisons
Introduction: Provincial Comparisons • Provinces can make important differences to practically
improving health and education on the ground.
• Understanding their individual challenges is vital to delivering better quality service delivery.
• They have a high degree of autonomy in deciding how increasing funds are spent and monitored.
Health Facility
Outputs
Infrastructure • Clinic Rooms • Housing
Materials • Drug availability • Medical supply kits
Health Workers • Numbers / Absent • Access to facilities
Funding • User Fees • Budgets and funding
sources
Spending & Activities
• Treat patients: operational clinic • Conduct outreach patrols to villages • Ensure drugs are available (incl AP) • Regular facility & housing maintenance • Transfer sick patients as required
Demand • Perspective on
quality of service
Oversight • Supervision • Community support
62 62
47
67
55
48
39
81
59
0
10
20
30
40
50
60
70
80
90
100
ENB WNB MOROBE SANDAUN EHP ENGA GULF NCD
Health Facility Type – Government & Church
Gov't
Church
Avg
• We surveyed more government - run health facilities than church facilities.
19
27
31 34
48
62
67
75
43
0
10
20
30
40
50
60
70
80
90
100
EHP MOROBE GULF SANDAUN ENGA WNB ENB NCD
Females Officers in Charge of health facilities: Gov't vs Church
All
Gov't
Church
Avg
• There were more female OIC’s for church-run health facilities in most provinces.
10.03 9.92 9.67
9.07 9.01
8.06
7.11
3.99
8.59
0
2
4
6
8
10
12
ENGA GULF SANDAUN EHP WNB MOROBE NCD ENB
Number of years OIC has worked in position at health facility
Years
Average
• Health OIC’s surveyed are usually very experienced so would have a deep understanding of the communities health needs.
24.5
54.4
17.2
69.1
37.6 35
43.8
115.2
35.4
60.5
32.4 30.3
24.5
31.7 32.1
95.4
0
10
20
30
40
50
60
70
80
90
100
110
120
ENB WNB MOROBE SANDAUN EHP ENGA GULF NCD
Patients visits in a typical day: 10 year comparison of matching facilities by province
2002
2012
Avg
Avg
• Patient visits have increased in Morobe as well as East and West New Britain but have fallen for the other provinces.
1. Infrastructure – Clinic rooms and housing
Health Facility
Outputs
Infrastructure • Clinic Rooms • Housing
50%
35% 26% 24% 21%
13% 12% 8%
24%
33% 37%
48% 47%
43%
58%
26%
20%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
WNB MOROBE GULF EHP SANDAUN ENB ENGA NCD
Clinic rooms that need rebuilding / maintenance
Maintenance
Rebuilding
Average
65%
58%
48% 44%
25% 21%
18%
10%
16% 28%
54%
48%
27%
57%
52% 60%
43%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ENGA WNB SANDAUN GULF MOROBE ENB EHP NCD
Health worker housing that need rebuilding / maintenance
Maintenance
Rebuilding
Average
94% 93%
63%
70%
50%
63%
36%
0%
14%
33%
18%
29%
20%
0% 0%
44%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
NCD ENB EHP MOROBE ENGA SANDAUN GULF WNB
Health facilities with electricy
All
Health Centre +
Aid Post
Average
87.5
100
71.4 75
70 66.7
50
62.5
14.3
50
0
8.3
0
9.1
0
48.2
0
10
20
30
40
50
60
70
80
90
100
NCD ENB EHP ENGA GULF WNB MOROBE SANDAUN
Health facilities with refrigeration (%)
All
HC plus
Aid Post
Average
79%
50%
25%
50%
30% 25%
38%
0%
14%
0% 0%
9%
0% 0%
8%
25%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ENB ENGA NCD WNB MOROBE EHP SANDAUN GULF
Health facilities with good/adequate access to an ambulance (inc. boat for coastal facilities)
All
HC +
Aid Post
Average
38% 38% 32%
23% 19% 17% 17%
9%
25%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ENB NCD ENGA WNB MOROBE SANDAUN GULF EHP
Health Facilities with good/adequate access to beds with mattresses
All
HC +
Aid Posts
Average
2 - Drugs Availability
Health Facility
Outputs
Materials • Drug availability • Medical supply kits
89%
97% 100%
57%
95%
77% 75%
96% 96%
29%
83%
59%
86%
73%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Panadol Fansidar Chloroquine TB blister packs Condoms Liniment
Availability of six comparable drugs/medical supplies: Matching Facilities 2002 - 2012
2002
2012
Avg
Avg
• The availability of all the following drugs and medical supplies have declined in the last 10 years.
95% 94% 91% 90%
81% 78%
62% 62%
82%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ENGA SANDAUN EHP ENB NCD GULF WNB MOROBE
Panadol - Availability and % facilities charge
Availability
Charge
Average
95% 91% 90% 89% 89%
85%
78% 75%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
MOROBE EHP ENB SANDAUN ENGA WNB GULF NCD
Amoxicillin - Availability and % facilities charge
Availability
Charge
Average
58% 55%
48%
33%
26%
17%
13%
8%
32%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ENGA EHP ENB MOROBE GULF SANDAUN NCD WNB
Baby books - Availability and % facilities charge
Availability
Charge
Average
• Baby books was one of the most common items where health facilities charged patients
75
62
53 48 46 45 44 42
52
0
10
20
30
40
50
60
70
80
90
100
NCD ENB ENGA GULF WNB EHP SANDAUN MOROBE
Malaria RDT - Availability and % facilities charge
Available
Charge
Avg
90%
81%
73%
48% 46% 42%
39% 33%
56%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ENB NCD EHP GULF WNB ENGA SANDAUN MOROBE
Mala wan (1) - Availability and % facilities charge
Available
Charge
Average
93.3
88.9
84.2
68.4
60 59.1 57.9
38.5
69.6
83.8
49.1
0
10
20
30
40
50
60
70
80
90
100
NCD SANDAUN ENGA ENB EHP GULF MOROBE WNB
Health Facilities that have received 40% drug kits
All
HC plus
Aid Post
Avg
Avg
Avg
68.4
56.3
52.6 50 50
45.5 42.9 42.1
51.1
0
10
20
30
40
50
60
70
80
90
100
ENGA NCD GULF SANDAUN EHP WNB ENB MOROBE
Health workers satisfied with contents of medical supply kits
All
Hc plus
Aid Post
Avg
3 - Health Workers
Health Facility
Outputs
Health Workers • Numbers / Absent • Access to facilities
9
6.12
9.5
5
6.87
4 3.72
5.71
7.1
3.37
6.5
4.82 4.5
4
2.54
3.57
5.8
2.87
5.5
3.18 3.125 2.83
1.72
3
0
2
4
6
8
10
12
NCD GULF ENGA SANDAUN WNB ENB MOROBE EHP
2012 (PEPE) Matching: Number of health workers posted, turn-up and present
Posted
turn up
Present
10.4
9.5
7 6.36
4.75 4.5
3.63 3.28
9.9 9.37
6.5
5.18
2.87
4.16
2.45 3
8.2
5.75
5 4.9
2.75 3.16
2
2.85
0
2
4
6
8
10
12
NCD GULF ENGA SANDAUN WNB ENB MOROBE EHP
2002 (PESD) Matching: Number of health workers posted, turn-up and present
Posted
Turn up
Present
89%
69% 67% 67%
54% 50%
47%
33%
59%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ENB WNB EHP NCD SANDAUN ENGA GULF MOROBE
Health Workers paid at official grade
All
HC plus
Aid Post
Average
90%
84%
78% 77% 76% 75%
64%
39%
73%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ENB ENGA SANDAUN WNB MOROBE NCD EHP GULF
Health Workers paid on time
All
HC Plus
Aid Post
Average
44%
38% 37% 35% 33%
21% 18%
16%
31%
0%
10%
20%
30%
40%
50%
60%
70%
80%
NCD WNB MOROBE GULF ENB SANDAUN EHP ENGA
Health Workers paid eligable allowances
All
HC plus
Aid Post
Average
69%
57% 52%
37%
19% 14%
11% 9%
34%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
WNB ENB GULF ENGA NCD MOROBE SANDAUN EHP
Health Workers with alternative source of income
All
HC plus
Aid Post
Average
847.5
727.1
496.2
455.8
253.5
62.3
19.8 2.3
365.8
0
100
200
300
400
500
600
700
800
900
1000
SANDAUN WNB MOROBE GULF ENB EHP ENGA NCD
Cost in kina to collect pay and return to post: All expenses - Accom and travel
All
HC Plus
Aid Post
Average
92.3
88.9
85 84.2
81
65 62.5
20
75.2
0
10
20
30
40
50
60
70
80
90
100
WNB SANDAUN GULF ENGA MOROBE ENB NCD EHP
Health workers that use their own salary to deliver health services
All
HC plus
Aid Post
Avg
4 – Funding and user fees
Health Facility
Outputs
Funding • User Fees • Budgets and funding
sources
75
54
50
10
0
16
48
0
75
54
50 50
36
16 14
0 0
10
20
30
40
50
60
70
80
GULF SANDAUN ENGA NCD MOROBE ENB EHP WNB
Health facilities that offer free service: Do not charge patients for consultation
2002
2012
• The same health facilities surveyed in most provinces are just as likely to offer a free service now than they did in 2002 with some exceptions.
100
90.5
81.8
75 71.4
44.4 42.1
30.4
64.1
0
10
20
30
40
50
60
70
80
90
100
WNB ENB EHP NCD MOROBE SANDAUN ENGA GULF
Health Facilities that charge adults for general consultation
All
HC plus
Aid Post
Avg
100
90.5
81.8
71.4
50
33.3 36.8
30.4
59.2
0
10
20
30
40
50
60
70
80
90
100
WNB ENB EHP MOROBE NCD SANDAUN ENGA GULF
Health Facilities that charge children for general consultation
All
HC plus
Aid Posts
Average
15.5
18.3
20.4
28.9
26.8
0
5
10
15
20
25
30
35
40
45
50
Disease test Vaccination Ambulance Stiches Night Ward
Health Facilities that charge children for the following visitations
All
Gov't
Church
• Different treatments often mean different costs. Some facilities even charge children for vaccinations.
28.9 31
55.6
50
58.5
0
10
20
30
40
50
60
70
80
Maternal Care Births / delivery Tribal Fight Domestic violence - Policereport
Domestic violence - Care
Health Facilities that charge adults for the following visitations
All
Gov't
Church
• The costs for treatment after a tribal flight or domestic violence is much higher than other treatments. Usually more than 20 kina per treatment is charged, even in rural areas.
1019.74
607.38 575.19 561.11
490 446.51
129.93
59
487.74
0
200
400
600
800
1000
1200
1400
1600
ENB ENGA MOROBE EHP WNB NCD SANDAUN GULF
Average monthly user fee raised at health facilities
All
HC plus
Aid Post
Average
• There are large variations in user fees collected across provinces.
Of budgets submitted to the district health office in 2012, only health centres in two provinces received any funding at all:
– East New Britain: K35,750
– Morobe: K5,020
80
37.5
33.3 30
23.5
18.2
14.3
10.5
31.1
0
10
20
30
40
50
60
70
80
90
100
ENB EHP WNB MOROBE SANDAUN GULF NCD ENGA
Health Facilities that prepare any kind of budget to receive funding (%)
All
HC plus
Aid Post
Avg
56.3
40.9 40
31.6 30.8 30 27.8
22.2
35.5
0
10
20
30
40
50
60
70
80
90
100
NCD GULF MOROBE ENGA WNB ENB SANDAUN EHP
Funding providers purchase supplies and materials on behalf of health facility (%)
All
HC plus
Aid Post
Avg
• Often funding for health facilities is kept by district and church funding providers.
60.9 60
53.8 52.4 50
42.9
31.3
22.2
46.4
0
10
20
30
40
50
60
70
80
90
100
GULF EHP WNB ENB SANDAUN MOROBE NCD ENGA
Funding providers supported health facility through health programs and activities
All
HC plus
Aid Post
Avg
• Provincial, district and church funding providers even support health facilities with their core responsibilities.
38.55
22.85
4.16 3.7 2.24 1.73 1.53 1.19
0
10
20
30
40
50
60
ENB WNB ENGA EHP MOROBE GULF SANDAUN NCD
Average number health patrols conducted in 2012 per health facility
All
HC Plus
Aid Post
Avg
Funding and support has significant implications for providing basic health services.
64.3
50
33.3 30
12.5 9.1
6.3
0 0
10
20
30
40
50
60
70
80
90
100
ENB WNB ENGA MOROBE EHP GULF NCD SANDAUN
Percentage of health centres that conducted more than 5 outreach patrols in 2012
HC plus
Avg
The proportion of health facilities that carry out regular patrols also varies across provinces and is an important minimum priority activity funded through the health function grant.
100
90 88.2 87
84.2
50
55
23.1
74.1
0
10
20
30
40
50
60
70
80
90
100
MOROBE EHP SANDAUN GULF ENGA NCD ENB WNB
Health facilities that sometimes or never have fuel to pick up / deliver drugs
All
HC plus
Aid Post
Avg
Delivering drugs is another important minimum priority activity to increase medical supplies. Especially drugs ordered through Area Medical Stores.
52.9 50
40
27.8 23.8 23.1
15.8 12.5
30.3
0
10
20
30
40
50
60
70
80
90
100
ENB SANDAUN EHP ENGA GULF WNB MOROBE NCD
Health Facilities that carried out basic routine maintenance in 2012
All
HC plus
Aid Post
Avg
So minimum priority activities, like facility maintenance, funded through the health function grant are not regularly carried out.
87
81 78.9 77.8 76.2 76.9
72.7
50
76.1
0
10
20
30
40
50
60
70
80
90
100
GULF MOROBE ENGA SANDAUN ENB WNB EHP NCD
Health facilities that can transfer patients to referral health center/hospital never or only sometimes in 2012
All
HC plus
Aid Post
Avg
Almost all aid posts cannot transfer patients to health centres which is important for rural/remote communities.
22.7 22.2 20
17.6
11.1 12.5
0 0 0
5
10
15
20
25
30
35
40
GULF ENGA ENB MOROBE SANDAUN NCD WNB EHP
Percentage of health facilities that received DSIP funding
All
HC plus
Aid Post
Avg
96000
127500
49000
134333.33
33500
? 0 0 0
20000
40000
60000
80000
100000
120000
140000
160000
GULF ENGA ENB MOROBE SANDAUN NCD WNB EHP
The average value of a DSIP health project
Kina
0
75 75
33
0
100
0 0 0
20
40
60
80
100
GULF ENGA ENB MOROBE SANDAUN NCD WNB EHP
DSIP health project has been completed in-full and on-time
finished
62.5
55.6
42.9
19 18.2 13
10.5
0
28.2
0
10
20
30
40
50
60
70
80
90
100
NCD SANDAUN ENB MOROBE EHP GULF ENGA WNB
Health Facilities that believe DSIP is a fair system
All
HC plus
Aid Post
Avg
93.8 88.9
57.1 57.1 54.5
73.9 78.9
92.3
0
10
20
30
40
50
60
70
80
90
100
NCD SANDAUN ENB MOROBE EHP GULF ENGA WNB
Health Facility should be able to apply for DSIP funds
All
HC plus
Aid Post
Avg
5 – Oversight and Supervision
Health Facility
Outputs
Oversight • Supervision • Community support
76.9
40 37.5
27.8
34.8
23.8 18.2
5.3
31.9
0
10
20
30
40
50
60
70
80
90
100
WNB MORO NCD SAND GULF ENB EH ENGA
Health facility has no supervisor
All
HC plus
Aid Post
Avg
0
33.3
12.5
76.9
53.3
31.3
50
27.8
39.8
0
10
20
30
40
50
60
70
80
90
100
WNB MORO NCD SAND GULF ENB EH ENGA
Health Facilities with supervisor has no visits in 2012
All
HC plus
Aid Post
Avg
87.5
54.5 52.6
39.1 33.3
28.6 27.8
15.4
41.5
0
10
20
30
40
50
60
70
80
90
100
NCD EHP ENGA GULF ENB MOROBE SANDAUN WNB
Health facility has an operational Village Health Committee
VHC
Average
84.2
72.2
54.5 52.4
43.5 38.5
31.3
19
49.3
0
10
20
30
40
50
60
70
80
90
ENGA SANDAUN EHP ENB GULF WNB NCD MOROBE
Health Workers conduct promotion activities in the community
promotion
Avg
88.9
65.2 66.7
60 57.9
56.3
45
27.3
59.7
0
10
20
30
40
50
60
70
80
90
100
SANDAUN GULF WNB ENB ENGA NCD MOROBE EHP
Community member volunteers to assist health facility
All
HC plus
Aid Post
Avg
6 – Demand for services from community
Health Facility
Outputs
Demand • Perspective on
quality of service
75%
67% 63%
56%
43% 39%
15% 14%
45%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ENB WNB ENGA NCD EHP SANDAUN MOROBE GULF
Community members surveyed that often visit the health facility
All facilities
Average
89% 83%
80% 73%
60% 57% 56% 50%
69%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ENGA SANDAUN ENB WNB MOROBE GULF NCD EHP
Community member thinks health workers spend most days working at the health facility
All Facilities
Average
57%
0%
43% 50%
67%
25%
80%
100%
55%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ENB WNB MOROBE SANDAUN EHP ENGA GULF NCD
Community member chooses health facility because it is in close proximity
All Facilities
Average
43%
100%
43%
25% 33%
50%
20%
0%
36%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
ENB WNB MOROBE SANDAUN EHP ENGA GULF NCD
Community member chooses health facility because of better quality service
All Facilities
Average
0% 0% 0% 0% 0%
25%
0% 0% 3% 0%
20%
40%
60%
80%
100%
ENB WNB MOROBE SANDAUN EHP ENGA GULF NCD
Community member chooses health facility because the cost is low
75%
58%
55%
50%
45%
40%
21%
7%
6%
16%
15%
17%
14% 20%
50%
53%
38%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
NCD ENGA ENB SANDAUN GULF MOROBE EHP WNB
Community members think health service provided is very good / adequate
Adequate
Very good
Average
Summary
• Generally there is large variation across the provinces but some provinces are performing better than others.
• East New Britain is performing well. Is this because it has more funding available through user fees and functional grants?
• NCD is also a good performer but is this because of location?
• More remote provinces like Gulf and Sandaun face significant logistical challenges, which seem to impact health services.
Summary…
• Enga province seem to have high community satisfaction of health services provided.
• More remote provinces, like Sandaun, also seem to offer more community support.
• Provinces will provide more details of their context and help interpret findings