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 roadmap, established under the National Health Administration Act 1997. Its vision is a healthy and prosperous nation in which all people enjoy health and wellbeing; its goal is to prevent ill health, address risks and emerging diseases, and provide accessible, affordable and quality healthcare for all. Its mission is for communities, government and partners to work together to promote wellbeing and deliver compassionate, equitable, quality care.[1][2]

• Align health-sector action with Vision 2050, the Papua New Guinea Development Strategic Plan 2010–2030, Medium-Term Development Plans, the Sustainable Development Goals, universal health coverage and international health-security commitments.[3][4][5]
• Deliver five Key Result Areas: engage communities for healthier communities; work together in partnership; increase access to quality and affordable health services; address disease burdens and targeted priorities; and strengthen health systems.[3][1][6]
• Strengthen primary healthcare, Essential Health Packages of Care, National Health Service Standards and integrated clinical and public-health services, particularly for rural, remote and disadvantaged communities.[7][8]
• Address communicable and non-communicable diseases, cancer, trauma, family health, nutrition, sexual and reproductive health, environmental health, immunisation and preparedness for outbreaks, emerging threats and pandemics.[9][10]
• Reduce geographical inequities, recognising poorer health status in rural areas and a 17-year difference in life expectancy across provinces.[11]
• Achieve national 2030 targets to increase life expectancy from 65 to 70 years, reduce under-five mortality from 45 to below 20 per 1,000 live births, and reduce maternal mortality from 171 to below 100 per 100,000 live births.[12]
• Build a competent, retained and adequately distributed workforce, targeting an increase in the workforce-to-population ratio from 1.01 to 1.62 per 1,000 people and 29,376 workers by 2030.[13][14]
• Reform medical and pharmaceutical supply systems to ensure an adequate, continuous, safe and affordable supply of quality medicines and essential commodities.[15][16]

Implementation

Implementation uses a unified, decentralised National Health System in which Provincial Health Authorities lead provincial community-service delivery, while the National Department of Health sets policy and standards, supports system integration, coordinates the sector and holds programmes and provinces accountable to communities.[6][17]The plan is supported by implementation guidance, programme interventions, health-status analysis and provincial and district profiles, with Provincial Health Authorities expected to update corporate plans and Health Services Development Plans that inform Annual Implementation Plans.[1]

• Coordinate delivery among the National Department of Health, Provincial Health Authorities, District Development Authorities, local-level governments, provincial administrations, churches and faith-based organisations, non-government organisations, community groups, private providers, other government sectors and development partners.[6][18][17]
• Integrate services across six facility levels, linking community health posts and health centres with district and rural hospitals, provincial hospitals, specialist referral services and the National Teaching and Specialist Referral Hospital.[8][13]
• Rehabilitate and upgrade health facilities, equipment, laboratories, medical stores and digital infrastructure in accordance with service standards, population needs, disease burden, geography and community priorities.[15][19]
• Strengthen community delivery through Village Health Assistants and Community Health Workers, community engagement, local planning, sustainable incentives and community-based support for disability, mental health and social change.[6][18]
• Develop workforce capacity through accredited pre-service and in-service education, postgraduate and specialist training, multiskilling, rural deployment, professional registration and licensing, and improved workforce information systems.[20][21]
• Reform supply chains through demand-driven procurement and distribution, decentralised planning, quantification, contracting, inventory control, provincial distribution, standard operating procedures and strengthened pharmaceutical regulation.[20][22][16]
• Establish the National Institute of Public Health, beginning with a National Reference Laboratory, to standardise laboratory services, support surveillance and outbreak response, monitor antimicrobial resistance and test medicine quality.[13]
• Implement an integrated National Health Information System by digitising facility reporting, integrating parallel systems into a data warehouse, incorporating private-provider reporting, strengthening infrastructure and workforce capacity, and expanding research and population-based surveys.[23][24]
• Measure performance through a Monitoring, Evaluation and Learning Plan and Performance Assessment Framework with agreed indicators, baselines and targets across the five Key Result Areas.[20][23]Conduct quarterly national and provincial reviews, annual comprehensive reviews, a mid-term review in 2024 and a final review in 2029.[24][25]
• Require Provincial Health Authorities to submit annual reports to the Minister for Health and HIV and AIDS, with the National Health Board approving the Sector Performance Annual Review and the Minister presenting an annual statement to Parliament.[24]
• Finance the plan primarily through government tax-based funding, supplemented by development partners, while pursuing facility-based and activity-based budgeting, stronger public financial management, public-private partnerships, innovative self-financing and a possible Health Endowment Fund.[20][15][16]
• Mobilise potential additional revenue through regulated fees, tobacco taxes and licensing revenue, potential alcohol or other health-related taxes, and a proposed health promotion trust fund.[26]
• Plan for estimated ten-year financial commitments of approximately 42.7 billion Kina in 2020 prices, including approximately 21 billion Kina for infrastructure, 6.5 billion Kina for government-managed human resources and 307 million Kina for pre-service training.[19]

Monitoring & Evaluation

The plan establishes a monitoring, evaluation and learning system centred on a Performance Assessment Framework (PAF), quantifiable indicators, integrated health information, regular performance review and formal reporting to government and Parliament.[20][23][24]It also prioritises surveillance and information-system strengthening to improve decision-making, service quality, emergency preparedness and accountability across national, provincial and facility levels.[5][11][9][27]

• Define indicators across the five Key Result Areas through the Monitoring, Evaluation and Learning Plan and PAF, including input, output, outcome and impact measures, baselines, targets and activity timing.[20][4][23]
• Measure progress against medium-term 2025 and long-term 2030 benchmarks, including targets for life expectancy, under-five mortality, maternal mortality and workforce density.[12][27][14][19]
• Collect data from facility and service records, administrative reports, facility assessments, household surveys, censuses, operational research, civil registration and vital statistics.[24]
• Strengthen the National Health Information System by digitising facility reporting, integrating parallel systems into a data warehouse, expanding networking, incorporating private-provider reporting, improving research and population surveys, and disseminating results through reports and data-visualisation platforms.[17][23][24]
• Improve mortality surveillance and establish integrated birth and death reporting, recognising that civil registration is the definitive source of mortality data and that existing information systems capture only a limited proportion of deaths.[11][18]
• Conduct quarterly national and provincial performance reviews, annual comprehensive reviews and annual PAF progress reporting; undertake a mid-term review in 2024 and a final review in 2029 to inform the subsequent plan.[20][24][25]
• Require Provincial Health Authorities to submit annual reports to the Minister for Health and HIV and AIDS, enable National Health Board approval of the Sector Performance Annual Review, and support an annual ministerial statement to Parliament.[24]
• Strengthen surveillance, laboratory capacity and reporting for communicable, emerging and notifiable diseases, including International Health Regulations capacities for detecting, assessing, notifying and responding to public health emergencies.[5][9][10][13]
• Monitor compliance with standards, accreditation, professional registration, licensing, supply-chain performance, public expenditure allocations and Provincial Health Authority performance through National Department of Health oversight.[10][21][16][28]

Health information and surveillance arrangements also encompass monitoring morbidity, mortality, service utilisation, disease burden, antimicrobial resistance, medicine quality and workforce deployment.[11][29][30][13][21]The supplied extracts do not specify indicator definitions, data-quality protocols, accountability sanctions or complete reporting schedules for every programme area.[9][17][8]

Costing & Financing

Implementation is primarily financed by the Government of Papua New Guinea through tax-based public funding, with development partners expected to support funding gaps and contribute an estimated 20% to 30% of health-system support.[20][16]The plan estimates total financial commitments of approximately PGK 42.7 billion in 2020 prices over 2021-2030, rising from approximately PGK 3.7 billion in the first year to about PGK 4.8 billion by 2030.[19]

• Allocate approximately PGK 21 billion for health infrastructure investment over 2021-2030.[19]
• Provide approximately PGK 6.5 billion for government-managed human resources for health, including existing personnel and incentive payments, and an additional PGK 307 million for pre-service training of new staff.[19]
• Implement the Human Resources for Health Strategic Plan at an estimated cost of around PGK 6.8 billion over 2021-2030, including rural incentives, rehabilitation of training institutions, pre-service training and investment to double workforce numbers.[22]
• Apply staff-resource assumptions that exclude cost-of-living adjustments and casual staff, and fill one-third of the gap between existing and target workforce levels by 2025, with the remainder filled during 2026-2030.[23]
• Provide approximately Kina 520 million for incentive payments and other strategic-objective-related expenditure, alongside Kina 307 million for pre-service training over the plan period.[23]
• Improve financial management through facility-based and activity-based budgeting, visible allocations linked to health-sector functions, stronger public financial management, annual planning and budgeting, and regular funding for medical supplies.[15][27]
• Explore additional financing through a Health Endowment Fund, public-private partnerships, tobacco-related taxes and fees, regulated private-practice and inspection fees, and potential taxes on alcohol or other products.[15][26]
• Establish essential-resource thresholds and predictable appropriations to protect basic services from economic shocks, disasters and fiscal constraints, while mobilising support from subnational governments, businesses, communities, civil-society organisations and development partners.[28]

Financial resources are expected to remain constrained, with economic pressures associated with declining export revenue, population growth and the effects of the COVID-19 pandemic.[20][2][13]Out-of-pocket contributions are considered an unsustainable source of additional funding because household capacity is relatively low.[20]Government per-capita health expenditure fell from 123 Kina in 2011 to 67 Kina in 2018.[31]The extracts do not provide a quantified overall funding gap, detailed programme-level annual allocations, unit costs or a comprehensive costing methodology beyond the stated estimates and assumptions.[16][26][19]