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Big health donors defraud patients by ignoring corruption

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STAFF REPORTERS | The Tokaut Blog | Extract

You can read the complete PNGi article here

PORT MORESBY - Papua New Guinea’s health system is in crisis.

Tuberculosis is at epidemic levels, polio has re-emerged, maternal and child mortality rates are among the worst in the world, malaria infections have increased nine-fold in just three years, no radiology treatment is available for cancer patients, rural health clinics lie empty and abandoned….

The list goes on and on.

Yet this is a health system that for decades has been financially and technically supported by some of the world’s largest multilateral agencies, the World Bank, the United Nations, the World Health Organisation, the Australian Department of Foreign Affairs and Trade and many others.

Why is their assistance so manifestly failing?

This year Australia will provide $572 million in overseas direct aid to PNG, 18% or $103m is being targeted at the health sector.

In addition, Australia has just announced an extra K24 million in funding to combat vaccine preventable diseases, starting with Polio.

Australian Minister-Counsellor based in Port Moresby, Benedict David says, “under the leadership of Minister Temu and the National Department of Health, this additional support will help protect PNG’s children from polio and other childhood illnesses”.

It is a worthy aspiration but about as far from reality as it is possible to get. Benedict David is either incredibly ignorant, which we doubt, or he is simply misinforming the public.

Australia and other overseas donors have poured billions of dollars into PNG’s health sector over the past decade.

Yet under the ‘leadership’ of Minister Puka Temu and Health Secretary Pascoe Kase, the National Department of Health (NDoH) has overseen a steady decline in health outcomes and the re-emergence of diseases such as polio and an impending tuberculosis crisis.

The reason for this decline in the public health service is not hard to find. PNGi has previously reported on numerous independent and government reports that expose chronic corruption and mismanagement within the health department.

Just last week, PNGi revealed a GAVI [the global vaccine alliance] investigation that found NDoH staff engaged in sophisticated and widespread financial fraud.

Now, another report has emerged from the same organisation. It is a program audit of the government’s expanded program of immunisations.

The expanded program of immunisations is managed by a unit within NDoH. It was established in 1977. It is considered by the national government to be “an important, cost-effective intervention for reducing the morbidity and mortality of children from communicable diseases”.

The GAVI audit strongly disputes this assessment, labelling the programs overall performance ‘unsatisfactory’ [the lowest possible rating] and concluding its objectives are unlikely to ever be met.

The unsatisfactory rating applies across the whole spectrum of the program’s operations.

The majority of issues identified in the audit as contributing to the unsatisfactory ratings were deemed to be “critical risk” [the highest possible grading], meaning a failure to take remedial action could result in ‘major consequences’ affecting ‘overall activities and output’.

The GAVI audit found that over a two-year period (2014-15) more than 25% (US$720,000) of GAVI funded expenditure by the expanded program of immunisations was misused or wasted and over 250,000 doses of vaccine (worth a further $50,000) were rendered useless through shelf expiry or inadequate temperature controls.

But what is even more shocking is that the audit only examined expenditure funded by GAVI.

The expanded program of immunisations unit is also supported, “technically and financially”, by donors including the Australian Department of Foreign Affairs and Trade, World Bank, World Health Organisation, United Nations Children’s Fund and Rotary International.

How much funding from these organisations has similarly been poured into the expanded program of immunisations unit and then been misused? According to the national health plan for 2011-2015, it could be as much as $18 million. That was the funding gap expected to be met by “donor partners”.

Given the fundamental nature of the management failures identified in the GAVI audit, there is every reason to expect that at least 25% of funds from all the EPI “donor partners” was similarly misused…..

Seventeenth century English writer and politician Henry Wootton famously described an ambassador as being “an honest gentlemen sent abroad to lie for the good of his country” and, of course, there are many times when a diplomat must bite their tongue for the sake of good relations.

But the suspicion in Papua New Guinea is that when it comes to public health, overseas donors and aid agencies are more interested in fulfilling their mandate to spend the considerable sums of money at their disposal rather than ensuring effective outcomes.

While there are undoubtedly many good and dedicated people working in the ranks of WHO, UNICEF, DFAT etc, the failure of the organisations they work for to call out the corruption and mismanagement in the National Department of Health is defrauding the public of any hope of decent health services in the foreseeable future.

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