Health Service Delivery in Papua New Guinea and Determinants Influencing Health Outcomes: The Case of Women and Health

Abstract

This study aims to uncover the determinants influencing health outcomes and investigates health service delivery in Papua New Guinea (PNG) within the context of women and their health. Despite extensive research on health and health service delivery in PNG over the past three decades, little or no improvement has been made to attain better health outcomes. Various factors which were found to contribute to PNG’s poor health outcomes, include poor financial management and resource allocation, complex institutional structures and challenges following government’s reform policies, lack of capacity, rugged geographical conditions and lack of essential infrastructure. These are mainly provider side factors with experiences of health service users largely understudied. My research adopts qualitative data collection methods, including focus groups discussions, questionnaires, in-depth interviews, observations, body-mapping exercises and illness narratives to understand women and their health service usage, and health workers providing health care. Fieldwork was conducted in three geographically, linguistically, culturally and religiously diverse locations in PNG. Over 100 people participated, including health workers and women.

The subsequent data was analysed and showed that women were prevented from using health services by factors existing on user and provider side, such as financial constraints, unfriendly health workers, and long waiting time at health facilities. Their personal values encouraged them to seek health care, such as consideration of familial responsibilities and trust in health workers. Although determinants were similar across the three locations, the degree of influence of the determinants varied in the context of the geographical and socio-economic environments. Medical pluralism exists in PNG with a large number of women using natural therapies and home remedies in rural and urban areas. Informal agencies were influential sources of their health knowledge. Health was narrowly confined to biomedicine and efforts to improve health outcomes handled solely by the health sector. However, health outcomes are not the result of use of biomedical health services alone but result of economic policies, political systems, educational programmes, social and cultural beliefs and practices regarding wellbeing. Thus, health outcomes need not be confined to biomedical disciplines but be a multidisciplinary and multisectoral responsibility, involving formal and informal institutions impacting all determinants and dimensions of people’s health.

Intersectoral collaboration between relevant disciplines, sectors and agencies at various levels are suggested in recognition of this. Many factors discussed in this study are likely to be amenable to interventions that are beyond the scope of the health domain. The PNG Department of Health has relatively little influence over many issues affecting individuals providing and using health services. While medical standards and training health workers may be within its scope, improving rural roads to increase access to health services often require assistance from other sectors. Multidisciplinary and multisectoral approaches are needed to address all determinants of health and improve health outcomes. Preventive primary health care through community-based approaches should be the focus. Appropriate methods that adequately capture human phenomena be used in health research. Any service delivery and development studies should include providers and users of services.