First impressions from seeing in 2008, at Oro Province the very many dilapidated or empty (or both), the structures once supposed and installed to operate as "village clinics", those edifices to the courage of folk becoming citizens in their own independent nation, they were at first the trophies. Some recognition of human need.
Buildings for delivery of education were a different matter, as of the services within. At the outset of many, request may have been presented to an available agency (cash strapped mission etc) and the actual service delivery came only when the community provided the buildings.

Few of the village clinics seem to have that initiation, namely a full commitment from the local community, as evidenced by the desire for and achievement of 'permanence' of materials. Procedures for maximising health service delivery have long been 'bastilled' in a manner of cleanliness with buildings aping that modelling.
No criticism of Rotary intended in saying an 'airdrop' of a health centre, any more than of national government in expectancy of this as 'rite procedure'. Help is appreciated. Longevity of usage is the open end.
As for national government, in 2008, I saw documentation of the then preferred building type, presumably the village clinic model having insufficient internal floor area, so the direction had become 'go larger'.

These few words do not a policy make, but for folk who have stayed with this comment, consider another model, one that is more ambulant. Here I do not suppose fleets of Asian 4WD vehicles but rather service deliveries leveraged on experience in the months of Covid-19, each scoped to the matter most prevalent and the terrain, and staffing.

Education is the word for systemisation of learning and evidently it is a whole of life challenge as a chore, more so at outcrops of enculturation which laden the national health expenditure with a local level mindedness that is tied to putting its eyes on trophies.

I entirely agree with your observations that corruption throughout the public service is, to quote the late Sir Mekere Morauta, both systematic and systemic and the principal reason for the moribund state of services.

I believe it is fair to say that the property of the commons belongs to no one and is purloined at an appalling rate.

I have also observed that if you were to try to steal a pig, retribution is likely to be severe and swift.

My point is that while people may shrug their shoulders upon hearing that the local health manager abuses the use of the district health services vehicle, they will by comparison vigorously defend what they know to be theirs.

And that is a central tenet to my thesis that communities will defend property including services that they have worked for and own.

The model I propose then is not entirely reliant upon a functional government to deliver basic primary healthcare service at community level.

Certainly, services would be greatly enhanced if government delivered, but if it did not essential front line primary healthcare services would continue regardless, under the auspices of community effort and their own people trained to provide these services.

This concept was shared by the late deputy secretary for health, Dr Paison Dakulala who observed similar approaches to primary healthcare service delivery in other parts of the world.

I was fortunate enough to attend community meetings in rural settings with him and to discuss these ideas with him in some depth.

He admitted that the implications of this vision were beyond the capacity of the National Department of Health or its sub national agencies to implement alone, but that in partnership with communities and other actors this approach in PNG should work.

So, when I hear someone propose that the solution might involve getting closer to communities, I envision a holistic multi-sectoral approach to primary healthcare that is grounded in communities from the start and that is not entirely subject to the vagaries of government funding for its existence.

Higher level service provision, whether that be in health or education then becomes an integrated deliverable into the component that communities are capable of doing for themselves.

The design of community-funded and owned components of service provision has been the challenge to which I have applied myself for some years.

I am pleased to say that with a like-minded group of PNG health professionals, tradespeople, financial and community leaders this vision has now crystalised into a deliverable program.

Your sensible ideas and optimism are laudable Stephen but the elephant in the room is corruption, not just at the national level but at the local level too.

For such a sensible system to work corruption has to be removed from the equation. Successive PNG governments have shown they are incapable of dealing with corruption and are, in fact, heavily enmeshed in it themselves.

Before anything can work equitably in PNG corruption has to be heavily constrained and law and order given precedence.

Lindsay, yes and no. The authors of this paper are quite correct in their assumption that greater effectiveness will be achieved by working “closer” to communities.

Connecting with community leadership to assist them to derive solutions to their needs is an essential way forward.

The challenge is to ensure these interventions integrate with government services through a government community partnership to deliver practical solutions and not become an alternative stand-alone service.

Empowering communities to strengthen resilience to the effects of climate change, improve food security and play a practical role in facilitating the basic health and education services they need is a major part of the equation going forward.

This requires a workable partnership. An understanding that communities are the untapped human resource that holds the key to extending what are in essence technical services all the way to the base where they are needed most.

A number of senior health managers I have spoken to agree with this approach.

The government already encourages partnerships with the private sector, NGOs, churches, and civil society groups. It needs to take the next step and engage with community leadership, both men and women.

This has to be approached with care and sensitivity. I would suggest working closely with government administrators, planners and with community leaders and spokespersons in the same room from the onset to ensure the needs of all are aired and the goal of a workable partnership is not lost sight of.

Government holds the key to delivering the pathways to human capital development. Communities are the land which defines a person’s identity upon which 85% of the population live. If the starting point recognises these fundamental building blocks the idea has enormous merit.

I am a supporter of this approach and believe it has the potential to help close the gap between underfunded and understaffed government services and long-suffering communities. It won’t be easy or quick, but with good will on both sides I am confident it will work.

I would like to acknowledge the point made by Professor Tidwell who has noted that the United States Institute of Peace are a think tank and not USAID. I take heart from his assertion that “meanwhile the actual work is being quietly considered by USAID.”

Just a quick comment on the United States Institute of Peace (USiP). They are not part of the US executive branch and have no policy-making role. They are a congressionally funded entity whose main task is promoting research and understanding on conflicts. Their most meaningful role is to promote dialogue. A well known scholar on Bougainville, Anthony Reagan, did a fellowship at USIP when he wrote his book, Light Intervention. USIP has no role in development policy nor any meaningful role in how USAID do their job. Take issue with the blog piece produced by USIP all you want, but don't overstate USIP's role. Meanwhile, the actual work is being quietly considered by USAID.

"Implementers should recognise that the incentives of political leaders may not align with leverage points for change, creating the risk that funds may not reach the right opportunities."

That's one of the most convoluted definitions of corruption I've come across.

"The US should avoid areas of support where Australia is heavily engaged, such as in police and defence training and basic health and education, and instead find areas of comparative advantage.

"Issues related to natural resource extraction, particularly mining, could be one such area."

Australia is up to its neck in "resource extraction".

"A potential multiplier for US government engagement could be coordination with ExxonMobil, PNG’s largest international investor, on community engagement and policy issues."

Now we know where they are coming from.

At least they recognise that "grassroots engagement at the community level offers the greatest opportunity for creating change."

Beware of Yanks bearing gifts I think.
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There were also a number of schoolboy howlers in the piece that, for reasons of factual accuracy, were edited out. If this tosh is typical of the intellectual basis of US policy on PNG and the Pacific, China looks very sporting - KJ