National Health Plan 2021-2030: Volume 1A Policies and Strategies

Objectives

The National Health Plan 2021–2030 is Papua New Guinea’s governing health-sector policy and implementation framework, intended to advance a healthy and prosperous nation in which all people can enjoy health and wellbeing. Its central commitment is that leaving no one behind is everybody’s business, with health treated as an investment in national development.[1][2][3]The plan aligns with Vision 2050, the Papua New Guinea Development Strategic Plan, the Sustainable Development Goals, the National Health Administration Act 1997 and International Health Regulations (2005) obligations.[4][5][6]

• Engage healthier communities by enabling people, families and communities to take ownership of health priorities, participate in planning, prevent ill health and address risks across the life course.[1][7]
• Work in partnership across government, communities, churches, non-governmental organisations, development partners, private providers and other sectors affecting health, including nutrition, education, water, sanitation, housing, income and the environment.[2][7][8]
• Increase access to quality and affordable health services through integrated primary healthcare, Essential Health Packages of Care, referral systems, outreach and services for rural, remote and disadvantaged populations.[5][9][10]
• Address disease burdens and targeted priorities, including communicable diseases, non-communicable diseases, cancer, trauma, mental health, maternal, newborn, child and adolescent health, disability, nutrition, environmental health and pandemic preparedness.[3][9][11]
• Strengthen health systems through improved governance, infrastructure, workforce capacity, medical supplies, health financing, information systems, research and quality assurance.[5][12][13]

The plan promotes universal health coverage as access to promotive, preventive, curative, rehabilitative and palliative services of sufficient quality, with financial protection.[14]It seeks people-centred, equitable, integrated and evidence-based service delivery, while recognising substantial geographical inequities and weaker health outcomes in rural areas.[14][15]Priority system outcomes include improved service access and affordability, stronger primary care, resilient emergency capacity, a functional six-level facility network, reliable medicines and a sufficient, competent and appropriately distributed workforce.[16][17][18]

Implementation

Implementation uses a decentralised, whole-of-government and partnership-based model. The National Department of Health leads policy, standards, coordination, monitoring and sector planning, while Provincial Health Authorities are the principal vehicles for provincial implementation and are expected to translate the plan into corporate plans, health service development plans and Annual Implementation Plans.[2][16][19]The One System Tasol model assigns Provincial Health Authorities responsibility for provincial community service needs, while the National Department of Health provides policy and standards support and holds programmes and provinces accountable to communities.[7]

• Coordinate delivery across Provincial Health Authorities, district administrations, local-level governments, District Development Authorities, hospitals, churches and faith-based organisations, community organisations, non-governmental organisations, private providers, research institutions and development partners.[8][13][19]
• Operationalise strategies through provincial health service plans, corporate plans, strategic implementation plans, annual implementation plans and programme-specific policies, aligned with the National Planning Act 2016 and public-finance requirements.[12][13]
• Integrate clinical services, public-health interventions and primary healthcare across provincial, district and village levels, using district and rural hospitals as clinical hubs, health centres as intermediary referral facilities, and community health posts and health posts to link communities with formal services.[9][17]
• Strengthen community delivery through Village Health Assistants, Community Health Workers, nurses, outreach and community participation, especially in hard-to-reach areas.[7][20]
• Reform governance and regulation through strengthened Provincial Health Authorities, legislative reform, clinical governance, facility quality assessment, accreditation, professional registration and licensing.[16][11][20]
• Develop the workforce through pre-service education, continuous upskilling, specialist training, recruitment, retention and improved deployment; the plan projects health-worker density increasing from 1.01 to 1.62 per 1,000 population between 2018 and 2030.[5][21]
• Reform medical supply chains through demand-driven procurement, better quantification, inventory control, storage, distribution, regulatory oversight and measures to reduce wastage and stock-outs.[22][18][23]
• Strengthen laboratory, surveillance and emergency functions through a National Institute of Public Health, beginning with a National Reference Laboratory, and through local, provincial and national International Health Regulations capacities.[14][17]

Monitoring, evaluation and learning are embedded in implementation. The National Department of Health is to measure progress across the five Key Result Areas using the National Health Information System and monitoring guidance, while a Performance Assessment Framework defines indicators, baselines, targets, responsible parties and government levels.[24][25]Monitoring covers inputs, outputs, outcomes and impacts, drawing on facility, administrative, survey, census, research and civil-registration data.[24][25]Provincial Health Authorities report annually to the Minister for Health and HIV and AIDS; national and provincial quarterly assessments, annual sector reviews and published progress reports support accountability.[25]A mid-term review is scheduled for 2024 and a final performance review for 2029, with health partners participating in review processes.[25][26]

Financing is expected to remain predominantly tax-funded by the Government of Papua New Guinea, supplemented by development-partner support and exploration of self-financing mechanisms.[23][27]The estimated ten-year financial requirement is approximately 42.7 billion Kina in 2020 prices, including around 21 billion Kina for infrastructure, 6.5 billion Kina for government-managed human resources and 307 million Kina for pre-service training.[28]Implementation emphasises stronger public financial management, facility-based budgeting, predictable allocations to Provincial Health Authorities and prudent prioritisation because resources are constrained.[12][29]

Monitoring & Evaluation

The National Health Plan 2021–2030 establishes a Monitoring, Evaluation and Learning framework to measure progress against five Key Result Areas, agreed targets and plan objectives, using the National Health Information System and monitoring and evaluation guidelines.[22][24]The framework is intended to support evidence-based decisions, performance management and accountability across national and subnational health-sector institutions.[24][25]

• Define a core indicator set, with baselines and targets agreed through the Performance Assessment Framework and aligned with national and international commitments, including Vision 2050, the Sustainable Development Goals and universal health coverage.[22][24]
• Track input, output, outcome and impact indicators, including resource mobilisation and use, service coverage and access, intervention results, and longer-term health effects.[22][24]
• Draw data from facility and service records, administrative and management records, health-facility assessments, household surveys, censuses, operational research, and civil-registration and vital-statistics systems.[25]
• Strengthen the National Health Information System through electronic facility reporting, integration of parallel systems into a single data warehouse, hospital networking, a health-sector-wide area network, improved infrastructure and workforce capacity, health research, and private-provider reporting.[13][24]
• Require Provincial Health Authorities to report annually to the Minister for Health and HIV and AIDS, while the National Health Board approves the Sector Performance Annual Review, including performance against Performance Assessment Framework indicators and targets.[25]
• Conduct national quarterly performance assessments, comprehensive annual reviews, provincial quarterly reviews and annual publication of Performance Assessment Framework progress reports showing sector-wide and provincial progress and service-delivery gaps.[22][25]
• Undertake a mid-term review in 2024 and a final performance review in 2029, with broad stakeholder participation, to assess progress, barriers, strategic adequacy and achievement of goals, and to inform resource allocation, budget disbursement and the subsequent 2031–2040 plan.[22][25][26]
• Strengthen disease surveillance, timely reporting of notifiable and emerging threats, laboratory quality assurance, outbreak response, antimicrobial-resistance monitoring and medicine-quality testing through the proposed National Institute of Public Health and National Reference Laboratory.[9][11][17]
• Apply quality and regulatory accountability through compliance monitoring, Provincial Health Authority performance evaluation, accreditation, professional registration and licensing, and pre-market and post-market controls for medical supplies.[11][20][18]

Costing & Financing

The plan is framed as a realistic and affordable ten-year programme in a constrained fiscal environment, with primary financing responsibility assigned to the Government of Papua New Guinea and continuing support expected from development partners.[22][3][7]Total financial requirements are estimated at approximately 42.7 billion Kina in 2020 prices for 2021–2030, rising from about 3.7 billion Kina in 2021 to 4.8 billion Kina in 2030.[28]

• Allocate estimated requirements across infrastructure, workforce investment, medicines access, Provincial Health Authorities, faith-based services, the National Department of Health, other institutions, disease priorities and associated recurrent costs.[28]
• Provide approximately 21 billion Kina for infrastructure investment, including hospitals, Levels 1–4 facilities, medical stores and a National Reference Laboratory.[28]
• Provide approximately 6.5 billion Kina for government-managed human resources for health and 307 million Kina for pre-service training during 2021–2030.[28]
• Estimate implementation of the Human Resources for Health Strategic Plan 2021–2030 at around 6.8 billion Kina, including rural staff incentives, rehabilitation of training institutions, pre-service training and investment to double workforce numbers.[18]
• Include approximately 520 million Kina for incentive payments and other expenditure related to strategic objectives during 2021–2030.[24]
• Finance the sector predominantly through tax-based government revenue, with donors and development partners estimated to provide approximately 20–30% of support; private insurance and out-of-pocket contributions remain limited.[23]
• Avoid reliance on increased out-of-pocket payments, as community capacity to contribute is described as low and further increases are not considered sustainable.[22]
• Improve public financial management through facility-based budgeting, possible activity-based budgeting, more predictable appropriations, bottom-up expenditure estimates, and accountability for Provincial Health Authority budget allocations.[12][29]
• Mobilise supplementary resources through development partners, provincial and district governments, private-sector groups, churches, non-governmental organisations, charitable organisations and communities.[8][23][29]
• Explore innovative financing, including a Health Endowment Fund, hospital fee reviews subject to statutory free-service requirements, regulated private-practice and inspection charges, tobacco-related revenue through the health promotion trust fund, and possible health-related taxes such as alcohol taxes.[12][27]
• Recognise that declining export revenue, the COVID-19-related economic downturn and anticipated reductions in per-capita spending constrain domestic health financing; no quantified overall funding gap is specified.[22][23]