Exploring Factors Driving the Performance of Rural Health Care in Papua New Guinea
Examining performance patterns of sub-national units, such as provinces and districts, within a health system is important to understand their drivers and what might be needed to improve outputs. Such literature is relatively rare in low and middle-income countries. It is particularly relevant for...
| Main Authors: | , , |
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| Format: | Policy Note |
| Language: | English |
| Published: |
World Bank, Washington, DC
2018
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| Subjects: | |
| Online Access: | http://documents.worldbank.org/curated/en/611831528823049450/Exploring-factors-driving-the-performance-of-rural-health-care-in-Papua-NewGuinea http://hdl.handle.net/10986/29875 |
| Summary: | Examining performance patterns of sub-national units, such as provinces and districts, within a health
system is important to understand their drivers and what might be needed to improve outputs. Such
literature is relatively rare in low and middle-income countries. It is particularly relevant for Papua New
Guinea, which is underperforming in relation to its neighbours and targets for core health indicators and
faces particular geographical challenges, with a dispersed and diverse population. In this analysis, we undertake simple correlation analysis between remoteness of populations,
expenditure on frontline services and core outputs by provinces and regions, such as antenatal care,
outpatient visits, outreach clinics, referrals of patients and facility supervision in 2012. In the context of
the challenging geography of Papua New Guinea, these are expected to be important factors. Some
expected patterns were found – for example, between remoteness and higher service costs, as well as
between remoteness and higher outreach services. Outpatient visits, however, increased with
remoteness, which was surprising. Our correlation analyses suggest a virtuous circle operating in some
areas (even in the most geographically challenged) between outreach clinics, immunisation coverage,
supervision, frontline spending and overall health system performance, which merits further investigation
into the factors supporting these and how they can be reinforced elsewhere. Whilst expenditure did not
correlate closely with provincial performance, it was evident that the provinces with higher performance
across the selection of metrics typically were also the higher spenders on frontline services. There was
some correlation of higher performance with density of public provision. More fine-grained assessment,
including at the district level, will be needed to understand the low levels of outreach clinics, transfers
and supervision, all of which are critical for quality health care in these kinds of contexts. The analysis illustrates what can be learned from combining routine data sources, as well as the limits and
the need to complement such analysis with more detailed local qualitative investigations. It also reinforces
the message that local leadership, supportive supervision and resources directed to frontline services can
be effective in raising health system performance, even in challenging settings. |
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