IRIN NEWS & ANALYSIS
ALTHOUGH IT IS RICH in natural resources, Papua New Guinea’s health staffing levels are comparable to the world’s poorest countries due to a rapidly retiring workforce and lack of qualified replacements.
“If we do not do anything about our ageing workforce quickly, the health system may collapse,” former health minister Jamie Maxton Graham told parliament in 2012.
Despite repeated warnings of the shortage since 2002, the country faces what the government calls a “drastic” health worker shortage. A World Bank report has predicted a large decline in nurses and midwives, the backbone of rural service delivery, by up to half.
Rural health care is especially threatened, noted 2011 field research led by Care Australia and the Australian National University.
Health experts say the shortage of qualified nurses is due to falling government support for nursing schools since 1999, which has forced the closure of all but three of the eight public nursing schools.
The team leader of the World Bank report, Aparnaa Somanathan, told international media in 2011: “I think training capacity in PNG has weakened considerably over the last 10-15 years. There is less and less resources being put into training, so PNG’s ability to train more and more doctors and nurses has declined.”
Fourteen community health worker schools produce graduates who work mainly in facilities in rural areas - where 90% of the population lives - mostly in aid posts.
Churches or faith-based groups operate aid posts, which are staffed with a nurse or community health workers. In areas largely bereft of government services, they provide frontline primary care and become the de facto village doctors.
The World Health Organisation recommends at least 23 health workers per 10,000 residents; PNG has five nurses and doctors per 10,000.
“Many of our qualified nurses have taken up employment in the resource sector for better pay and conditions,” said Manga Bengi, a public relations officer with Mount Hagen Provincial Hospital, the country’s third largest.
Meanwhile, with poorly-funded health training opportunities, almost no midwives have registered with the state since 2000. However, since the Australian government gave $120 million last year for midwifery training, a new group of midwives is due to graduate this month.
Even so, these graduates will be far outnumbered by the number of health workers expected to retire soon. Out of 570 doctors, 3,429 nurses and 4,400 community health workers, 20% have passed the legal retirement age of 55, while nearly 40% are aged 45-55.
Nurses will retire the soonest, with more than one-third of specialist nurses (including midwives) expected to retire in the short term, according to a 2011 health profile by the Australia-based University of New South Wales and health think tank Burnet Institute.
Prime minister Peter O’Neill told local media in December that foreign workers are needed as a stop-gap measure.
About 10 years ago, former prime minister Sir Michael Somare moved to bring in nearly 100 nurses and doctors from Cuba on temporary work contracts, but the cost and heated opposition from the local medical community of being “replaced” by foreign workers stymied the effort.
The present government’s latest bid to import health workers has met similar resistance, but plans proceed.
The current state of health manpower training in the country is appalling.
We have known for at least a decade that we would be running into a shortage of health workers. Millions of kina have been spent in the last five years or more on meetings and workshops by the Health Department on this issue and there is still no official directive from it.
The minister has expressed concern and announced recently that a national policy will be released soon.
The report above has at least one misleading comment. We are led to believe that it has only been due to the release of Australian funding that midwives will be graduating this year. This is a blatant untruth.
UPNG’s Nursing Division has been working for several years on a midwifery training program (i.e. from UPNG) that could be registrable by the Nursing Council; a task that mysteriously took on mammoth proportions culminating in last year’s batch of students at least eligible for registration.
AusAID funding has been a welcome relief with sponsorship of students, provision of academic staff and now infrastructure development; however this is only for midwifery.
The training of doctors in UPNG is severely hampered by a lack of teaching staff (currently 50% of positions vacant), deteriorating infrastructure and inadequate financial support (UPNG in the red by K70 million).
The current ceiling for an intake of 50 students per year cannot be exceeded under current conditions. It is only surviving due to supplemental support from AusAID through its HECS (Health Education & Clinical Support) program.
The training of rural HEO’s is also hampered by inadequate clinical training releasing poorly prepared graduates out into the workplace.
A report several years ago commissioned by DWU itself was quietly shelved as was a report by OHE. Some effort has been made to deal with this but it requires systemic change.
Nursing schools have been poorly funded and supported. We need the opening of more nursing schools. Last year 200 positions for nurses was advertised for PMGH; there were no applicants at all.
This is compounded by problems with Nursing Council registration in which midwives had been trained for several years but unable to be registered.
Lastly, the 14 community health worker training schools are all run by the churches and are in considerable difficulty keeping their heads above water.
Moreover there are no mechanisms in place to systematically monitor and ensure regular updating of knowledge and skills of all levels of health workers (from doctors to CHWs).
There are no provisions to have regular licensing requirements so that in fact most of the aging workforce is probably redundant in terms of knowledge and skills.
Still, the health department has not released any official report as to how they plan to systematically fix the human resources problem.
Posted by: Paulus Ripa | 17 March 2013 at 10:11 AM
A colleague arrived in PNG with his wife who is an experienced nurse.
She applied for a work permit and licence to practice and waited nearly four years before giving up. While waiting she did voluntary work helping at a local clinic, but with limited duties naturally.
She has returned to her home country to be able to practice nursing, while her husband, my colleague has remained in PNG.
They don't even allow one nurse to practice. WTF?
Ohh! Penge, smart tru yah!
Posted by: Michael Dom | 17 March 2013 at 02:31 AM