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

2. 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.

3. 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

4. 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.)
NHP
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

5. 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

6. 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.

7. 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

8. 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

9. 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.

10. 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.

11. 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.

12. 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.

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

14. integrated program activity implementation planning framework

15. 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.
   

16. References
National Health Plan , 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 , Canberra: Australian National University Press.
World Health Organisation, (2013) Bulletin of the World Health
Organization

17. Thank you