Papua New Guinea ‘Quo Vadis’? (Whither Thou Goest?)
'Threats & untruths': Former UNRE boss accuses chancellor

DFAT health sector report pulls punches on a critical situation

Health Minister Puka Temu
Health Minister Dr Puka Temu administers oral polio vaccine - when the dreadful disease returned recently after 18 years, he tried to play down its impact


NOOSA – Australia’s foreign affairs department (DFAT) has just released a report evaluating the contribution that international donors have made to Papua New Guinea’s health system.

The report by Ian Anderson and Renee Martin was presented to DFAT last December, well before the recent outbreak of polio confirmed a shocking reality that many of us suspected - that health services in PNG are going downhill fast and have now reached a danger point.

The report, which you can read in full here, assesses the efforts of six multilateral development partners - the Asian Development Bank; the Global Fund to Fight AIDS, TB, and Malaria; the World Bank and three United Nations agencies, UNFPA, UNICEF and WHO – over a six year period.

Anderson and Martin have done what many consultants do when reporting upon big and powerful organisations – intimating problems while pulling punches about some of the most inimical reasons and about where real responsibility lies.

“The [multilateral development partners] have a generally good record in terms of their overall effectiveness in the PNG health sector,” they write, “but important challenges remain.”

My oath they remain. And they're more than challenges; they are realities that are killing people.

As commentator Matt Morris tweeted wryly, “….challenges like endemic corruption in drug procurement, funding cuts to pay for APEC, a collapsing health system and now polio.”

The C word is often avoided in official discussion about Papua New Guinea as it seems to be in this report (I have not done a full word check but the executive summary avoids it like the plague, if that's not too harsh a metaphor).

When I was in PNG earlier this year and uttered the word ‘corruption’, I was gently chastised by a senior public servant that “we don’t use that language here”.

When I asked how then this topic might be addressed, the response was that there are “significant inefficiencies”.

Matt Morris also pointed out that the report assigns no accountability to donors for the failing health system. And certainly DFAT escapes pretty much unscathed, perhaps because it commissioned the report and was considered not part of the game when in fact, as PNG's major donor itself, it is critical to it.

Australia has fiddled with but never candidly confronted the curse of corruption in the PNG government. DFAT has been part of a problem that is now too late to fix. Australia has seriously let down the people, as differentiated from the fat cats, of PNG.

But let me turn to some of the main points made in the report itself.

It says that the six multilateral development partners all contribute in different ways “according to their own mandates and comparative advantage” and that, “when well-coordinated [note the qualifier], the impact of these six agencies can be larger than the sum of their parts”.

Good old synergy, nice to assume, hard to measure. It crops up again towards the end of the executive summary.

It turns out that DFAT provided about $112 million to the six organisations from 2011–17 and felt itself to be “in a particularly good position to further leverage and magnify the important role played by the MDPs through judicious use of grant financing and policy dialogue”. Well one would hope so.

But let’s look at those important remaining challenges.

Unwittingly pre-empting the polio disaster, the report says that “immunisation rates have essentially stagnated for decades and in some cases declined” and “policy dialogue with [the PNG government] has had only modest success.” In other words, it is rather cavalier in taking notice of what we advise.

The report continues with a register of despair: PNG has the fourth highest rate of stunting in the world; maternal mortality remains one of the highest in the world; there are “stubborn weaknesses” in health financing and the provision of essential drugs to front line services; essential drugs run out of stock; and there is the “double burden of controlling communicable (including drug-resistant) diseases alongside the rapid rise of expensive to treat non-communicable diseases”.

Meanwhile, health spending is decreasing in real terms with a strong suspicion intimated that the PNG government is using donor funding not to add to its own funding but as a substitute for it – thereby depriving the health sector further.

And what are DFAT and the six partners doing about this? Well it turns out that “monitoring and evaluation remains the weak point” with “too many reports [being] descriptive and input-focused, rather than analytical and output/outcome focused.”

“DFAT will need to develop a clearer, overarching - as well as individual agency level- results framework that sets out what DFAT expects [partners] to achieve when using its funds,” the report recommends.

“DFAT also needs to be equipped, including with technical expertise where that is necessary, to be able to more proactively manage its ongoing relations with the MDPs and achieve a sharper results focus.”

Much consultant-speak there, but one later paragraph provides the tell-tale: “Declining levels of immunisation is a worrying reflection of the capacity of the health system more generally, and the ability to manage health security challenges more specifically.”

“But there are also opportunities,” the report says, as if to cheer us up. “PNG has a new Minister for Health who is clearly determined to improve health outcomes. PNG has had an ‘unprecedented’ reduction in the prevalence of malaria and appears to have avoided the early projections of an HIV AIDS crisis.”

And some solutions? The ADB is considering a “substantial” concessional loan, the World Bank has recently finalised a concessional credit and is also considering a concessional loan. These will all “further incentivise and drive reforms in public financial management in the health sector”. Further?

Finalising its executive summary, the report concludes: “DFAT itself is clearly committed to supporting GoPNG reform efforts in the health (and other) sectors…. It will, however, require a transition plan….”

Six years and $112 million later, we need a plan.

I think we need a lot more than that. Total honesty and candour in reporting for a start.


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Lindsay F Bond

Plague is the indifference inflicted
significant inefficiencies
Vague is the inexactness ‘inquisit’
significant in exigencies
Blagued is but symptomatically caused
sinecured explanatories.

Rashmii Bell

Best piece of writing I read last week.

Where words have failed me in my rage against several of DFAT's agencies/ donors in PNG, their lack of transparency, integrity and accountability- KJ has nailed it here.

Albert Schram

Not using the 'C word', suggesting it is somehow undignified, is ridiculous. If there is stealing of public funds, the auditor general is supposed to report it, and the culprits are supposed to be indicted.

More transparency and public debate will help diminish corruption, while tolerance, acceptance and silence will only perpetuate a situation of general impunity.

Lindsay F Bond

For an exercise on coordination of deliveries by public expenditures, consider a Queensland local government council which has a delivery of tree planting, yet without first a delivery of effective barricading against motor vehicles which continue in the practice of traversing turf areas so also annihilating newly planted trees. Location hint? Insularity.

For an exercise of coincidental similarity, again of public expenditures, consider a PNG governmental delivery of health infrastructure where paucity of provision for availability of water in the months of lesser rainfall, deprives those in need of care 'deliveries', a non-availability 20 hours in each 24 hour duration. Location? New buildings at Tufi.

For an exercise on consequential health budget delivery, in respect of Tufi, there might be a wages component that is compromised where staff are likely precluded from otherwise anticipated utility in 'deliveries'. For this comment, however, no staff person was consulted, no patient/client was interviewed, no GoPNG record was compromised, yet it seemed to be.

Mark Davis

Health is indicative of the entire Australian aid effort. And while LNP government / DFAT encourages corruption through its improper electoral and financial support of the O'Neill regime, nothing will change.

In the current circumstances, aid is simply a way of allowing O'Neill and his cronies to steal the government funds in the health system or which should be going to the health sector.

DFAT is fully conversant with the blatant corruption in the delivery of medical supplies, and other rorts, but has not been able to devise an effective response over many years.

AusAID was actually part of this scam some years ago, but its wailing and hand-wringing achieved nothing.

Politically and administratively, Australia is like a rabbit frozen in the headlights. I've downloaded the report and will read it today - it'll be good for a laugh like a lot of the output from government and academia.

Paul Oates

Plans are all very well but as has been said many times previously, even the best battle plans are mostly useless after the first shot is fired.

The avoidance of the 'C' word and using euphemisms to obfuscate what everyone knows is the truth is just an excuse to do nothing. Those who subscribe to this form of myopic amnesia are just as guilty as those who perpetrate the root cause of the problem.

The facts speak for themselves. Anyone who really wants to know what is wrong has merely to look at the financial equation. Just simply follow the money.

Given that solution appears to be about as popular as the plaque,it would seem that those who shy away from the truth are just as guilty as those who selfishly cause the problems.

Australia now has a new Foreign Minister who was reportedly nominated by her predecessor. Unless events prove otherwise, one can presumably expect more of the same.

However, our new PM has at least made an attempt to understand some of the issues by actually visiting and walking the Kokoda track. Whether he learnt from what he saw in that brief encounter with the kunai roots and can do something positive about our international relationship with PNG will become clear soon enough.

Organizations like the Lowy Institute have been shining a spotlight recently over the local modern version of the 19th Century 'Great Game' and have drawn the ire from those who prefer to be out of the spotlight.

If as expected, the US November primaries give President Trump dyspepsia, he therefore clearly can't see why his presence in Port Moresby might have been significant for this part of the world at this time. His Deputy will in anyway inevitably be shielded from reality inside a huge bullet proof automobile so it's unlikely he will see, smell or experience anything like reality.

One of the causes of the Second World War was the US belief that their isolationism would protect them from becoming involved in what was felt by many to be just another European war.

Well the way it's going, the chances of the next war breaking out in what the US regard as their backyard and their paternally regarded 'swimming pool' might just bring their external views rapidly back into focus.

It will be interesting to see if during his planned brief visit to our region, Mr Pence wears his dark glasses or whether is prepared to take them off however briefly and confront reality.

Philip Fitzpatrick

It should be possible to calculate how many lives would have been saved if the money spent on APEC was, instead, spent on health.

From that you should be able to deduce how many people APEC has killed in PNG.

Will Self

Very well said.

Have a Plan - that is a good idea.

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