Implementation planning of the National Health Plan in a decentralized health system in Madang province, PNG by Tabian Ambang 2018 PNG Update 14th of June 2018

Introduction National Health Plan (NHP) is a key policy document for the health sector in PNG (NDoH, 2011). NHP explains PNG government’s policy directions for the health sector in PNG and priority areas for planning and service delivery. The current publication (NHP2011) is the sixth edition – 1973 to 2011.

Background Implementation of NHP 1973 to 2010 (short/medium term plans – NDOH’s goals. 2011 to 2050 (long term plan - PNG Vision 2050. Decentralised health system (PNG): - NHP planning & documentation – NDoH - Implementation, Monitoring, Evaluation – Provincial & District Health Administrations. NHP 2011 - NHP 2050

PNG Vision 2050 (2010 – 2050) PNG Development Strategic Plan (PNGDSP) cont …. PNG Vision 2050 (2010 – 2050) PNG Development Strategic Plan (PNGDSP) (2010 to 2030 & 2031 to 2050) Medium Term Development Plan (MTDP) Sector Plan (Health, Education, etc.) NHP2011-2020 Provincial Development Plan (22 provinces in PNG) Provincial Dev. Plan (e.g. Madang Prov. Health Plan) District Development Plan District implementation plan (89 districts in PNG) Program implementation plan - Facility Dept. of Planning, PNG Govt, 2011

PNG Vision 2050 Planning in the Health sector, PNG cont …. PNG Vision 2050 7 pillars of development 1.Human Capital Development, 2.Wealth creation, 3. Institutional development and Service delivery, 4. Security & international relations, 5. Env. Sustainability 6. Spiritual, Cultural and Com. Development, 7. Strategic planning integration etc…. Ministry of Health Health Vision 2050 NHP2011 (2011 to 2020) NHP2021 (2021 to 2030) NHP2031 (2031 to 2040) NHP2031 (2041 to 2050) Provincial Administrations (Health) Provides direction for implementation District Administrations (Health Implementing policies, national plans and program activities Health facilities & Program Areas NDOH, PNG Govt, 2014

Study: Research topic This study investigated the implementation planning of the National Health Plan in Madang province, PNG. Aim to provide an understanding of the implementation planning of the NHP in a decentralised health system, 2011 to 2017. Methodology Research design: Qualitative. Data collection – in-depth interviews and written documents (operational plans & documents on NHP). Data analysis - content analysis (in each data set) to identify the codes. Thematic analysis - across data sets) to explain the relationship between the codes across the data sets and to develop themes.

Interview: Key Informants Managers of the health facilities and health program units at the provincial health office and in the districts in Madang provinces Health Provider Health Service No. of Participants Government Provincial 2 District 12 Church Lutheran Health Services 4 Catholic Health Services 7 Total 25

Written documents Total: 25 Operational plans – Rural hospitals & Health Centres Provider Facility Document Govt. Health Ser. 1.Provincial Health Office 2.District Health Office 3.Health facility Program operational plans X 5 District Health Plans x 6 Facility health plans x 6 Church - Lutheran 1.Provincial Office 2.Facility Operational plan x1 Operational plan x 2 Church Catholic Operational plan x 1 Operational plan x4 Total: 25

Findings Limited understanding of NHP - Content & structure - District Health Program Managers & Program Coordinators Cause factors: ineffective communication between the provincial health administration, district health administration and the health facilities particularly on planning and implementation of health policies & plans.

Cont. Findings Implementation planning - Strategic alignment between provincial health plan, district health plan and facility health plan – Use of a standard planning template – Program Budget Planning No strategic alignment between district health plan and district development plans, district administration & district health service – Districts do not have strategic plan, No integrated planning template.

Continue …. Decentralisation reform - More emphasis on structure and less effort on process and systems. Well documented plans/policies, are not implemented effectively in the districts . Management capacity issues in the province & districts– implementing the national development objectives at the local level. – Leadership, resources, good & governance Lack of continuous monitoring and evaluation -- implementation progress.

Opportunity for improvement Establishment of PHA – to take ownership of implementation planning & implementation process of health policies/Plans. Establishment of DDA – Partnership with PHA & Provincial Administrations. Structure reforms must accompanied by process and procedural reforms to ensure NHP key results areas and their strategic goals are integrated in the district development plan.

Suggestion The study suggested for an integrated program activity implementation planning framework at the district level.

integrated program activity implementation planning framework

Conclusion The study highlighted challenges health care providers experienced on implementing the NHP in a decentralised health system. The study suggested that an integrated implementation planning framework is required at the district level to link and align health program activity plans with NHP, district and provincial development plans. Strategic alignment through the process of integrated planning will provide opportunity for improvement To review the current implementation process in the province and district to facilitate effective implementation of NHP.    

References National Health Plan 2011-2020, NDoH, Govt. of Papua New Guinea. Bolger, J; Mandie-Filer, A; & Hauck, V. (2005). Papua New Guinea’s health sector: A review of capacity, change and performance issue. European Centre for Development Policy Management, Maastricht. Thomason, J; and Kase, P (2009). Studies from Papua New Guinea, Studies in State and Society, No.5 pp. 117-130, Canberra: Australian National University Press. World Health Organisation, (2013) Bulletin of the World Health Organization

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