The impact of decentralization on health workforce development in Papua New Guinea

Abstract

Papua New Guinea decentralized a wide range of health functions to provincial governments between 1977 and 1983. The national Department of Health (DOH) was given no role in provincial budget and staffing decisions, and the national health budget was fragmented into the health components of provincial budgets. The impact of decentralization on health workforce development was particularly severe and largely unforeseen. Many difficulties were inherent in the manner in which decentralization regulations structured power relationships. Others arose as a result of the administrative confusion and inflamed relationships that accompanied the forceful transfer of power from a very reluctant national DOH to the provinces. Even though policy formulation and planning were retained as national functions, decentralization hampered their effective execution. Human resource data bases deteriorated, responsibility for planning became confused, and the ability of the DOH to implement its planning decisions was compromised. In reality, health workforce planning was carried out by the Departments of Finance and Planning, and Personnel Management through the annual budgetary process of provincial financial limits and staff ceilings, without any attempt to assess health service needs, either in the country as a whole or between the provinces. Decentralization brought a need for new management skills, and it complicated administrative relationships between training institutions and the provinces. The Papua New Guinea experience has shown that in a decentralized health service, there is a great potential for conflict between national goals and the aspirations of individual provinces. To achieve an equitable, appropriate and effective staffing of services, standards must be formulated as the basis for planning and conflict resolution. Effective linkages between central government departments and between the national and provincial health authorities must be developed, and management and technical skills of health managers improved.

La descentralización de los servicios de salud: de la teoría a la práctica

“…Con algunas excepciones (72), el impacto que la descentralización ha tenido en otras regiones ha sido sorprendentemente parecida a lo que se ha documentado en América Latina (1,30,48,(73)(74)(75)(76)(77) ...hay poca evidencia de que esto es así. Al contrario, es más probable que un aumento en autonomía local o regional aumente las diferencias.…”

Exploring the sustaining factors that motivate nurses to work in the rural areas of Papua New Guinea

“…It has been argued that the introduction of the new health system in 1977 was initial cause of health workers refusing rural offers of work (Kolehmainen-Aitken, 1992). This was acknowledged by NDoH although surprisingly there was further decentralisation in 1995 to approximately 300 Local Level Government (LLG) organisations (Thomason & Kase, 2009).…”

“…These shifts of responsibilities without any necessary safeguards and checks resulted in the rural facilities lacking workers due to a lack of adequate social investment. One of the unforeseen effects of poor implementation of policy was the health workforce development; that is, a result of removing the DPM was a deterioration in human resources (Kolehmainen-Aitken, 1992). Furthermore, it is noted that decentralisation has had direct impacts on the decline of the rural health workers, and specifically nurses.…”

“…This means that the wantok system issues where people whom they know are given higher priority for higher responsibilities without considering their required merit status. As a result, most of the priority areas are overlooked because some of the people occupying such positions lack the leadership skills to identify and develop suitable strategies to address existing issues (Kolehmainen-Aitken, 1992). Hence, the policies and plans by NDoH are weakly coordinated.…”

Exploring the sustaining factors that motivate nurses to work in the rural areas of Papua New Guinea

“…This role was further redirected to the PHA by NDoH. However, in the process of transferring the role, the function was not defined clearly to NDoH by DPM (Kolehmainen-Aitken, 1992). Subsequently, without being fully aware of the role PHA had accepted, less was done to suppress the growing decline in health workers, such as nurses, in rural areas over the next several years.…”