Promoting Effective Public Expenditure Project. PNG s Lost Decade? Preliminary Health Survey Findings Provincial comparisons

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1 Promoting Effective Public Expenditure Project PNG s Lost Decade? Preliminary Health Survey Findings Provincial comparisons

2 Introduction: Provincial Comparisons Provinces can make important differences to practically improving health and education on the ground. Understanding their individual challenges is vital to delivering better quality service delivery. They have a high degree of autonomy in deciding how increasing funds are spent and monitored.

3 Infrastructure Clinic Rooms Housing Materials Drug availability Medical supply kits Demand Perspective on quality of service Health Facility Outputs Health Workers Numbers / Absent Access to facilities Oversight Supervision Community support Funding User Fees Budgets and funding sources Spending & Activities Treat patients: operational clinic Conduct outreach patrols to villages Ensure drugs are available (incl AP) Regular facility & housing maintenance Transfer sick patients as required

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5 Health Facility Type Government & Church Gov't Church 39 ENB WNB MOROBE SANDAUN EHP ENGA GULF NCD We surveyed more government - run health facilities than church facilities.

6 Females Officers in Charge of health facilities: Gov't vs Church Gov't Church 19 EHP MOROBE GULF SANDAUN ENGA WNB ENB NCD There were more female OIC s for church-run health facilities in most provinces.

7 12 Number of years OIC has worked in position at health facility Years Average ENGA GULF SANDAUN EHP WNB MOROBE NCD ENB Health OIC s surveyed are usually very experienced so would have a deep understanding of the communities health needs.

8 Patients visits in a typical day: year comparison of matching facilities by province ENB WNB MOROBE SANDAUN EHP ENGA GULF NCD Patient visits have increased in Morobe as well as East and West New Britain but have fallen for the other provinces.

9 1. Infrastructure Clinic rooms and housing Infrastructure Clinic Rooms Housing Health Facility Outputs

10 % Clinic rooms that need rebuilding / maintenance 9% % % % % % % % % % % 24% 48% 33% 47% 58% 37% 43% 26% % % 35% 26% 24% 21% 13% 12% 8% WNB MOROBE GULF EHP SANDAUN ENB ENGA NCD Health worker housing that need rebuilding / maintenance Maintenance Rebuilding Average 9% % % % % % 16% 65% 28% 58% 54% 48% 48% 44% 27% 57% 52% % 43% Maintenance Rebuilding Average % % % % 25% 21% 18% % ENGA WNB SANDAUN GULF MOROBE ENB EHP NCD

11 % 9% Health facilities with electricy 94% 93% % % % % % % % 14% 63% 33% % 18% % 29% 63% % 36% 44% Health Centre + Average % % 9 % % % NCD ENB EHP MOROBE ENGA SANDAUN GULF WNB Health facilities with refrigeration (%) NCD ENB EHP ENGA GULF WNB MOROBE SANDAUN HC plus Average

12 Health facilities with good/adequate access to an ambulance (inc. boat for coastal facilities) % 9% % % % % % % % % % % 9% 79% % % 38% % 25% 25% 14% 9% 8% % % % % % ENB ENGA NCD WNB MOROBE EHP SANDAUN GULF Health Facilities with good/adequate access to beds with mattresses 25% HC + Average % % % % % % % % 38% 38% 32% 23% 19% 17% 17% 9% 25% HC + s Average % ENB NCD ENGA WNB MOROBE SANDAUN GULF EHP

13 2 - Drugs Availability Materials Drug availability Medical supply kits Health Facility Outputs

14 Availability of six comparable drugs/medical supplies: Matching Facilities 2-12 % 97% % 96% 96% 95% 9% % % 89% 75% 83% 77% 86% 73% % 57% 59% 2 % % 12 % 29% % % % Panadol Fansidar Chloroquine TB blister packs Condoms Liniment The availability of all the following drugs and medical supplies have declined in the last years.

15 % 9% % % % % % % % % % Panadol - Availability and % facilities charge 95% 94% 91% 9% 81% 78% 82% 62% 62% ENGA SANDAUN EHP ENB NCD GULF WNB MOROBE Availability Charge Average Amoxicillin - Availability and % facilities charge % 9% % 95% 91% 9% 89% 89% 85% 78% 75% % % % % % Availability Charge Average % % % MOROBE EHP ENB SANDAUN ENGA WNB GULF NCD

16 % Baby books - Availability and % facilities charge 9% % % % % 58% 55% 48% Availability Charge % % 33% 26% 32% Average % 17% 13% % 8% % ENGA EHP ENB MOROBE GULF SANDAUN NCD WNB Baby books was one of the most common items where health facilities charged patients

17 Malaria RDT - Availability and % facilities charge Available Charge NCD ENB ENGA GULF WNB EHP SANDAUN MOROBE % 9% % % 9% Mala wan (1) - Availability and % facilities charge 81% 73% % % % % 48% 46% 42% 39% 33% 56% Available Charge Average % % % ENB NCD EHP GULF WNB ENGA SANDAUN MOROBE

18 Health Facilities that have received % drug kits HC plus NCD SANDAUN ENGA ENB EHP GULF MOROBE WNB

19 Health workers satisfied with contents of medical supply kits Hc plus ENGA NCD GULF SANDAUN EHP WNB ENB MOROBE

20 3 - Health Workers Health Facility Outputs Health Workers Numbers / Absent Access to facilities

21 12 2 (PESD) Matching: Number of health workers posted, turn-up and present Posted Turn up Present 12 NCD GULF ENGA SANDAUN WNB ENB MOROBE EHP 12 (PEPE) Matching: Number of health workers posted, turn-up and present Posted turn up Present NCD GULF ENGA SANDAUN WNB ENB MOROBE EHP

22 % 9% 89% Health Workers paid at official grade % % 69% 67% 67% % % 54% % 47% 59% HC plus % % 33% Average % % % % 9% % % % % % % % % % ENB WNB EHP NCD SANDAUN ENGA GULF MOROBE Health Workers paid on time 9% 84% 78% 77% 76% 75% 64% 73% 39% ENB ENGA SANDAUN WNB MOROBE NCD EHP GULF HC Plus Average

23 Health Workers paid eligable allowances % % % % 44% % % % 38% 37% 35% 33% 21% 18% 16% 31% HC plus Average % % NCD WNB MOROBE GULF ENB SANDAUN EHP ENGA Health Workers with alternative source of income 9% % % 69% % % % % 57% 52% 37% 34% HC plus Average % % 19% 14% 11% 9% % WNB ENB GULF ENGA NCD MOROBE SANDAUN EHP

24 Cost in kina to collect pay and return to post: expenses - Accom and travel HC Plus Average SANDAUN WNB MOROBE GULF ENB EHP ENGA NCD

25 Health workers that use their own salary to deliver health services HC plus WNB SANDAUN GULF ENGA MOROBE ENB NCD EHP

26 4 Funding and user fees Health Facility Outputs Funding User Fees Budgets and funding sources

27 75 Health facilities that offer free service: Do not charge patients for consultation GULF SANDAUN ENGA NCD MOROBE ENB EHP WNB The same health facilities surveyed in most provinces are just as likely to offer a free service now than they did in 2 with some exceptions.

28 9 Health Facilities that charge children for general consultation HC plus s Average 9 WNB ENB EHP MOROBE NCD SANDAUN ENGA GULF 9.5 Health Facilities that charge adults for general consultation WNB ENB EHP NCD MOROBE SANDAUN ENGA GULF HC plus

29 Health Facilities that charge children for the following visitations Gov't Church Disease test Vaccination Ambulance Stiches Night Ward Different treatments often mean different costs. Some facilities even charge children for vaccinations.

30 Health Facilities that charge adults for the following visitations Gov't Church Maternal Care Births / delivery Tribal Fight Domestic violence - Police report Domestic violence - Care The costs for treatment after a tribal flight or domestic violence is much higher than other treatments. Usually more than kina per treatment is charged, even in rural areas.

31 Average monthly user fee raised at health facilities HC plus Average ENB ENGA MOROBE EHP WNB NCD SANDAUN GULF There are large variations in user fees collected across provinces.

32 Health Facilities that prepare any kind of budget to receive funding (%) 9 HC plus ENB EHP WNB MOROBE SANDAUN GULF NCD ENGA Of budgets submitted to the district health office in 12, only health centres in two provinces received any funding at all: East New Britain: K35,7 Morobe: K5,

33 Funding providers purchase supplies and materials on behalf of health facility (%) HC plus NCD GULF MOROBE ENGA WNB ENB SANDAUN EHP Often funding for health facilities is kept by district and church funding providers.

34 Funding providers supported health facility through health programs and activities HC plus GULF EHP WNB ENB SANDAUN MOROBE NCD ENGA Provincial, district and church funding providers even support health facilities with their core responsibilities.

35 Average number health patrols conducted in 12 per health facility HC Plus ENB WNB ENGA EHP MOROBE GULF SANDAUN NCD Funding and support has significant implications for providing basic health services.

36 Percentage of health centres that conducted more than 5 outreach patrols in HC plus ENB WNB ENGA MOROBE EHP GULF NCD SANDAUN The proportion of health facilities that carry out regular patrols also varies across provinces and is an important minimum priority activity funded through the health function grant.

37 9 Health facilities that sometimes or never have fuel to pick up / deliver drugs HC plus 23.1 MOROBE EHP SANDAUN GULF ENGA NCD ENB WNB Delivering drugs is another important minimum priority activity to increase medical supplies. Especially drugs ordered through Area Medical Stores.

38 Health Facilities that carried out basic routine maintenance in HC plus ENB SANDAUN EHP ENGA GULF WNB MOROBE NCD So minimum priority activities, like facility maintenance, funded through the health function grant are not regularly carried out.

39 Health facilities that can transfer patients to referral health center/hospital never or only sometimes in HC plus GULF MOROBE ENGA SANDAUN ENB WNB EHP NCD Almost all aid posts cannot transfer patients to health centres which is important for rural/remote communities.

40 Percentage of health facilities that received DSIP funding GULF ENGA ENB MOROBE SANDAUN NCD WNB EHP The average value of a DSIP health project ? GULF ENGA ENB MOROBE SANDAUN NCD WNB EHP DSIP health project has been completed in-full and on-time GULF ENGA ENB MOROBE SANDAUN NCD WNB EHP HC plus Kina finished

41 Health Facilities that believe DSIP is a fair system NCD SANDAUN ENB MOROBE EHP GULF ENGA WNB Health Facility should be able to apply for DSIP funds NCD SANDAUN ENB MOROBE EHP GULF ENGA WNB HC plus HC plus

42 5 Oversight and Supervision Health Facility Outputs Oversight Supervision Community support

43 Health facility has no supervisor HC plus WNB MORO NCD SAND GULF ENB EH ENGA Health Facilities with supervisor has no visits in HC plus WNB MORO NCD SAND GULF ENB EH ENGA

44 Health facility has an operational Village Health Committee VHC Average 15.4 NCD EHP ENGA GULF ENB MOROBE SANDAUN WNB Health Workers conduct promotion activities in the community promotion ENGA SANDAUN EHP ENB GULF WNB NCD MOROBE

45 Community member volunteers to assist health facility HC plus 27.3 SANDAUN GULF WNB ENB ENGA NCD MOROBE EHP

46 6 Demand for services from community Demand Perspective on quality of service Health Facility Outputs

47 Community members surveyed that often visit the health facility % 9% % 75% % % 67% 63% 56% % % 43% 39% 45% facilities Average % % 15% 14% % % ENB WNB ENGA NCD EHP SANDAUN MOROBE GULF % 9% % % % % % % % % % Community member thinks health workers spend most days working at the health facility 89% 83% % 73% % 57% 56% ENGA SANDAUN ENB WNB MOROBE GULF NCD EHP % 69% Facilities Average

48 % 9% % % % % % % % % % % 9% % % % % % % % % % % % % % % % Community member chooses health facility because of better quality service % % 43% 43% 25% 33% % 36% % ENB WNB MOROBE SANDAUN EHP ENGA GULF NCD Community member chooses health facility because it is in close proximity % 67% 57% 43% % 55% 25% % ENB WNB MOROBE SANDAUN EHP ENGA GULF NCD Community member chooses health facility because the cost is low 25% % % % % % % % 3% ENB WNB MOROBE SANDAUN EHP ENGA GULF NCD % Facilities Average Facilities Average

49 % Community members think health service provided is very good / adequate 9% % 6% % 75% % % % 16% 58% 15% 55% 17% % 14% 45% % % % 38% Adequate Very good Average % 53% % 21% % 7% % NCD ENGA ENB SANDAUN GULF MOROBE EHP WNB

50 Summary Generally there is large variation across the provinces but some provinces are performing better than others. East New Britain is performing well. Is this because it has more funding available through user fees and functional grants? NCD is also a good performer but is this because of location? More remote provinces like Gulf and Sandaun face significant logistical challenges, which seem to impact health services.

51 Summary Enga province seem to have high community satisfaction of health services provided. More remote provinces, like Sandaun, also seem to offer more community support. Provinces will provide more details of their context and help interpret findings