STORY OF THE RASCAL LEADER WHO CAME TO THE OFFICE
He wanted to surrender. Police had shot a number of his lieutenants, some died on the spot, some died from loss of blood before they received treatment and some who were shot in the leg had their leg amputated. His conscience was hurting him because so many of his friends were being harmed. He explained.
He explained that he needed a job for himself and his boys. In exchange for surrender he wanted K10,000 to set up a business.
Coming from an Australian cultural background I saw a number of inconsistencies in his arguments which did not seem to make sense to me.
These were :-
Thus there must be a cultural backing for his argument. Along with Michael Goddard I believe that the `rascal' more for the cultural reasons than through need. Goddard points out that many of the `rascals' especially the leaders are educated at least as far as Grade 10. Many have held jobs but they are dissatisfied with their jobs because the job is poorly paid and lacks prestige. They aspire to be a bigman and a poorly paid job lacking prestige does not provide them with the prestige that they desire.
LIFE CYCLE OF THE RASCALS IS FAIRLY WELL KNOWN
Young men even while they are still at school begin to `Pilai criminal'. They drift in and out of the gang as the occasion occurs. Some drift out altogether but keep contact with the gang.
By 18 or 20 they become hard core rascals. At this stage many form their own `rascal' sub gang. I have met a dozen or so young men who claim to be the leader of the scorpions or the 585 (SBS) or some other gang. In reality they are members of that gang who have formed their own small sub groups, they continue this way until they are jailed or killed or shot. Then at about the age of 30 they have had enough. Some take the path of religion, others surrender, and others gradually move back into the regular society.
The `rascal' gang is a youth phenomenon and an example of the cultural traditional bigman applied to the urban environment.
AN UNDERSTANDING OF THE BIGMAN IN TRADITIONAL SOCIETY
The nature bigman in the Highlands differs quite noticeably from his counterpart in the coastal areas. In coastal areas villages tend to be a compact unit with some 80 to 100 families. The bigman in a coastal village lived right among his people and was available daily to hear this complaints, he was of necessity a wheeler dealer, manipulator and practical psychologist. Finally he was a person possessed of considerable personal power. He worked on the person to person relationship more than on public oratory. In the past the security and cohesion in the village depended on his personal qualities to control and maintain the internal security against magic and external security against the threats of neighbours.
In the Highlands where the villages were few and hamlets the norm, the essential qualities of the highland bigman were and still are a dynamic combination of industry generosity, grandiloquence oratory and cunning. He had to have the ability to accumulate personal wealth and power to provide perks for his followers. The highland style of bigman was much more aggressive than that of his coastal counterpart.
The features common to both Highlands and Coastal styles are :-
The bigman system has preserved the security of villages for thousands of years and as such has worked well. Today the bigman system like the wantok system has fallen into disrepute because of abuses and at the national level is no longer meeting the community needs. Most National leaders no longer live among their followers and so the check on them by their followers no longer works. They are in a position to ride rough shod over the wishes of their people particularly in matters were the community wealth is involved. They are no longer responsible for their people. Also with growing education and awareness people are becoming dissatisfied with the behaviour of their leaders as their reasonable needs are not being met. The bigman system is not to be rejected but reformed to meet present day needs.
The bigman system is an essential part of all culture of all the people living in NCD. It is the style of government they have learned from their parents and the only one they understand and with which they are really familiar.
In the NCD there are several hundred youth groups all of which know only the traditional bigman system of control. The situation still works reasonably because the leaders are still in direct contact with their followers so the checks are still in place. However there is still grave dissatisfaction. People have come to expect an equal share of the profits coming from their work. The capitalist system of salaries, unions and courts, the rise of women's voices, the voices of churches are all having the effect of raising expectations for justice for the grassroots.
EXPECTATIONS OF YOUTH
The NCDC have made the first steps in meeting this traditional need by setting up the City Rangers and the youth work groups. These activities provide public recognition, provide status and a small income. Keeping in mind the importance of prestige these two are a good start. According to Lucy Palmer the City Rangers and the youth groups are already provided an alternative for some of the `rascals'.
YOUTH ACTIVITIES AND STRATEGIES FOR PEACE AND UNDERSTANDING :
Always keeping in mind the need of the youth leaders for status and prestige there are other ways of utilising youth for peace and understanding.
The list is just a beginning and I am sure that a brainstorming session among youth would identify a dozen more valuable ideas.
Youth groups are organised on the bigman system and it would be counter-productive to attempt to banish it. It is ingrained. We must learn to work with the system and modify the features which make it unacceptable.
The most unacceptable features are :-
As long as these problems exist the City Rangers and the youth work groups will be flawed. To make these effective there is an urgent need for training especially among the leaders of youth groups both male and female. In youth groups it is the leaders who decide the nature, quality, attitudes and activities of the group and their ways of achieving their ends. If the leader has a bent for violence his followers will be the same; if the leader is community minded, his followers will be the same.
Essential to any good leadership are the following :-
Training youth groups in these skills is a major project but can be reduced by seeing the multiplier effect of the training by the more capable of the youth and using them as a resource to train others. This method has two advantages. It provides status for the leaders who become trainers and it can be achieved at a minimum cost.
Training by the Foundation for Law Order and Justice :
The Foundation for Law Order and Justice has developed courses which would help to achieve this goal. People skills, advanced conflict Resolution and Counselling. There are courses which run for two weeks, take in thirty people at a time, are gender balanced and are conducted on the adult education (workshop style). All courses are now conducted by trained Papua New Guineans. Already some 2000 people have had the benefit of these courses in Buka, 40 people in Buka are fully trained as trainers of people skills and 9 as trainers in advanced courses.
In the Central District courses have been run successfully at Aroma Coast, Taikone and Vabukori. Six (6) trainers have already completed their 10 weeks of training and are being used in the NCD at Taikone, Vabukori and Saraga. From Vabukori there are already three (3) fully trained trainers and another 10 are in the process of being trained from the three places. By the end of the year there will be about 16 people who have completed their 10 weeks of apprenticeship and received their certificates as fully trained trainers.
Plan for NCD Youth :
Not all the youth groups are able to find employment all the time and spend long periods of time waiting for their turn to come round again. During their time off work there is an opportunity to train them in People Skills. What would be needed would be identify the groups requesting training select the leaders (male and female) find a suitable location near to the group base and organise trainer to handle the training.
In Australia and New Zealand the courts recognise an alternative system to the courts. The aim is to treat youth as a special at risk group who need special handling. This is done through the restorative justice system which allows for a face to face meeting between the youth criminal and the victim and their families in the presence of a mediator. The aim is to keep youth out of jail and provide them with the opportunity to restore to the community for the damage that they have done.
In Buka the Village Court Inspector has requested permission to swear in 40 of the people trained by FLOJ as mediators in the wan-bel court. A number of trainers are already trained in this type of conflict resolution and are using it with success. In NCD such a process would have to be legalised by the courts.
INFORMATION BOOTHS :
Provide each of the main centres in NCD with an information centre for youth. This would not be an elaborate office but a small booth like the lotto offices. Their purpose would be to provide youth with information on their special needs. Health, registration, how to find money to projects. How to write a proposal, economy world bank rights and duties of citizens etc.
Location : Most of my remarks have been addressed to the situation in the NCD. This is not because I have ignored the provinces but because I have insufficient knowledge of the needs of youth there.
Further Notes - : On perusal of the Resolutions of Day 1 highlight the following :-
Department of Environment and Conservation (DEC) operates under the fourth goal of the National Constitution which states :-
The National Constitution outlines in more details the specific functions of the department -
"WE ACCORDINGLY CALL FOR."
The Department of Environment and Conservation has an existing administrative structure that implements the constitutional directives outlined above, consisting of three operational divisions and two branches that deals with corporate matters and services :-
Operational Divisions :
Corporate Services :
NOTE : Department of Environment and Conservation is currently undergoing restructuring of the Department to cater for the changes that are taking place.
DEC is responsible for administering the implementation of eight Acts of Parliament. These are :-
The Department on behalf of the Government also participate in and communicates with various international organisations to which PNG is a party.
DEC STRATEGIC DIRECTIONS 1996 - 1998
The Strategic Directions 1996 - 1998 for the DEC approved by NEC for implementation in 1997 - 1999 sets out broad strategic directions on what DEC will pursue over the next three years and the actions it will take during the first year to establish those directions. These directions are in line with the National Government Reforms on Provincial and Local Level Government Systems.
How can the Youth in PNG meaningfully PARTICIPATE OR INVOLVE themselves in the following activities at Provincial and Local Level?
Officers from the National Youth Service, distinguished guest, ladies and gentlemen. Thank you for inviting me to come and talk to you about "Youth and Education Reform" and to give you some ideas about how my department is trying to help increase access of more of our youths to higher learning institutions for their own self development and for our country.
Traditionally the only real special time when young people were treated as a separate group within their communities was at the time of initiation. At this time, young teenagers were involved in special ceremonies and tests that were carefully designed to initiate them into responsible and respective adulthood. After initiation a person was no longer treated as a child. Initiation therefore provided a very important youth program that everyone in the community understood, went through successfully and recognised as being very important.
Before initiation, young people were not treated as a separate group within their community. Instead they were like "INVISIBLE" members of their community. Today however, this situation has changed greatly. PNG has experienced many social changes over the last fifty to hundred years. New western ways has been introduced and accepted by our people such as western education, modern medicine, new forms of transport and communication, new laws etc. Some of these changes such as better health care have been helpful, while others like alcohol, illegal drugs like cannabis and gambling have been stumbling blocks to many people.
Often our young people have been the "VICTIMS" of these changes. Sometimes they have tried to rebel and fight against the difficulties that they are now forced to face, becoming involved in rascal gangs and crime. For this reason our society is becoming more aware of the special needs of young people that are often different from the past. Often also they are seen as the main trouble makers in their communities and are looked down upon by older people.
Government, community and church leaders often see young people as a separate "PROBLEM" group in need of special help and discipline. Many attempts have been made in recent years to think of ways of helping young people to become helpful members of their communities. The Education Department set up vocational centres and other forms of non-formal education. A special government department for youth was set up in 1985 to help direct the energies and abilities of young people into more productive and fulfilling activities within their communities. Even the police force was given more money in the past to try to control the problem of crime amongst young people.
Our church leaders were also worried about the changing behaviour of young people and recognised the need to design programs that would meet their spiritual, social and livelihood needs and youth leadership training was seen as very important. However, even today in 1996 the nation is still struggling to understand the needs of our young people in a rapidly changing world. There is still a lot of confusion amongst our people about how best to help the young people. Even the word "YOUTH" has been misunderstood by many in our communities. Some people think that youth means a business project such as poultry or fishing which any people can run whether they are old or young. Others think youth means people who are not married or who have no children.
But when we talk about youth, we are really talking about a special "AGE GROUP" of people. Usually we mean young people (boys and girls) between the ages of 12 and 25 years old. If we look at all the age groups from children to old adults, we see the that "YOUTH" fits in between, so we are looking at a special group of people who are no longer children but not yet adults, a group left in the middle who have very special needs.
Youth groups in PNG are usually voluntary associations made up of young men and women between the ages of 12 and 25 years and carry out their activities on a collective basis. These groups are organised through institutions such as the church, the boy scouts/girls guides movement, missionary societies or the village.
Many youth groups differ in terms of their internal structure and composition, in terms of the aims they set themselves and the types of activities they engage themselves in. These differences naturally are a result of the different economic, environmental, social, political and cultural circumstances within which they operate. Many youth groups in PNG are based on a rural environment, in communities where the wage economy plays a subsidiary role and where the social fabric is still tightly woven.
Having said that, what is the government's response to the problems and needs of our young people? This morning I have been asked to speak on the topic of "YOUTH AND EDUCATION REFORMS" and I want to mention a couple of things here because I believe our education system can offer some of the solutions to some of our problems with youth.
According to a recently published United Nation's report, Papua New Guinea has an embarrassing record in the areas of child nutrition, health and education. The report ranked PNG No. 10 (33%) in regional terms in the Asia/Pacific region which is below the regional average of 22%. In terms of education for example, the report states that there are 12% who are boys. This is a gloomy picture of PNG's standing as against those of other countries around the world.
The report states that girls' education is one of the "MOST POWERFUL" levers of progress. Girls' education is closely linked to wider opportunities for women, fewer maternal and child deaths, better child health and nutrition, later age marriage, higher rates of contraceptive use and falling fertility. Yet in almost every region fewer girls are in school than boys.
According to UNESCO statistics, the world numbers approximately 950 million men and women who do not possess the most elementary tools to assume their own development : reading and writing. Another appalling figure : more than 135 million children do not go to school. More than 60% of these are girls (UNESCO Education Report 1991 P21). These are world figures of which PNG is part and parcel of. PNG is still one of the least in terms of the provision of education services to all of its people in the South Pacific Region. There are many children across the country who still do not have a school because it is far away from their community, there is lack of space in the schools, or parents cannot pay the fees, etc. What can we do to increase access to primary and secondary education where the majority of youths should be learning about useful things? When these categories of "UNFORTUNATE STUDENTS" are not catered for in our planning for basic general education services they will become illiterates of tomorrow. In order to master reading and writing, a child must attend community school/primary school regularly for at least six years.
Often in the past education budgets had been geared toward the tertiary level of education which had an adverse effect on many remote/rural areas in PNG where the majority of the people and children are where building a good classroom and other school facilities was difficult due to shortage or money and other associated costs which were beyond the peoples income. This meant that schools were not built and children in those affected areas did not get a chance to attend a school, thus they became illiterates.
According to the 1990 National Census, approximately half of our people in PNG cannot read a simple paragraph and understand its meaning, and this is not only in English but in any of the eight hundred or so languages we have, and this is cause for concern because when half of our people are illiterate, it means half of our citizens cannot read and understand directions on the medicine bottle. They cannot read and understand a bank passbook. They cannot read and understand the bible or other meaningful books and they cannot read letters from family members or friends far away from them. This means they are cut off from many benefits and advantages many of us take for granted.
This is not a good picture for our country because when one looks at a world map, it is striking that those areas where the death rate for young children and mothers is highest is also the areas where illiteracy is high. Where the standard of living is low, is also the areas where the level of literacy is low because a generally low quality of life and low levels of literacy go together. Unfortunately, our nation, despite all our gold, oil, forest resources abundance of fish and other resources, still has a low level of literacy.
In 1990 also, over 50% of all PNG's population was under the age of 16 years. In fact over 64% of the population at that time was under the age of 25 years. If the 1990 National Census figures are to be correct it means that half of the population who could not read or write then would have included our youth who are now adults, and this is a very serious matter, ladies and gentlemen.
The National Government is now in the process of trying to do something about improving the situation through the education reform program, perhaps with a far more determined effort than ever before. Theoretically through the introduction of the education reform this phenomenon will gradually be corrected. The establishment of primary and secondary schools will enhance more students than ever before to gain basic education up to grade 8.
The old system of promoting students from one level of education to another has not served well those students who are supposed to be benefiting from the education system. Statistics from the old system clearly indicate that more than 50% of the children drop out of school before they reach grade 10. Further to that only a small number continues on to grade 12. What can the community and the provinces do to increase access to secondary schools?
A child enters grade one at seven years of age. Theoretically he/she continues to grade six. The child takes a qualifying exam to enter high school. A child may do well in the exam but because there are fixed number of places in grade seven they drop out. This means that only 36% of those that sit the grade 6 examination enter grade 7. The rest drop out. Only 10% of those that sit the grade 10 exam continue on to grade 11 and 12 in the four National High Schools (excluding secondary schools which are products of the reform). It is distinct that the old system pushed out many students and had serious implications for our young people. It meant for example, that many of them could not continue with their education or be old enough to find gainful employment so they could become useful members of the community. Instead, through no fault of theirs, they became "DROPOUTS" who were looked down on by the community.
EDUCATION REFORM AND ELEMENTARY/PRIMARY EDUCATION
How will education reform help with the problems of our young people? The education reform program will consider a broad range of educational opportunities for our young people. Under the arrangements for elementary and primary schooling for example, children will have nine years of general education as opposed to the old system which made the majority of children leave after grade 6, in simple terms the education reform will enable all children enrolled in the elementary schools to have a grade 8 education. In the new system children will have more opportunities to enter upper secondary schools. Employment opportunities have also been created for people at the village level to teach at elementary schools and earn an income.
Elementary schools will largely be a community responsibility. Infrastructure, building materials, classrooms and maintenance will remain the sole responsibility of the respective local communities that will be running elementary schools. In 1997 there will be approximately 300 elementary schools with an estimated 9,000 children enrolled. There will also be 128 primary schools to increase access into grade 7. The Department of Education will be responsible only for the training of elementary teachers, in service training and supervision.
In order to establish elementary education at the community level, community-based boards of management will be required to organise awareness and build, supply and maintain school classrooms and facilities. They should assist provincial planners and liaise with primary school head teachers in the clustering of elementary schools. Suitable community volunteers will be identified to participate in the development of the local vernacular curriculum to ensure sensitivity to the local culture, and to give recognition to the wishes of the community which it serves. Teachers will be nominated by the community.
At the provincial/district level, curriculum materials will be developed and produced with the help of district and provincial trainers, and technical assistance teams. Literacy awareness and material production centres will become operational and staff will be trained to provide materials production services as needed. Materials will be produced locally using methods such as silk-screen printing or at literacy awareness and material production centres with the help of interested church groups and non government organisations.
With regards to elementary teachers, candidates nominated and accepted for teacher training will complete a national elementary teacher certificate course, upon completion of which they will be registered as members of the teaching service. The teacher pupil ratios will be 1 to 30 at the preparatory level and 1 to 40 in elementary 1 and 2. Teachers will be trained to teach all grades within the elementary school. Multi-grade teaching will be an essential aspect of that training.
A provincial training team consisting of the provincial coordinator and teacher trainers will be established to implement all approved teacher training courses. The province is responsible for budgeting for teachers emoluments and salaries.
At the national level, the establishment of policies for elementary education will continue, with the development of an elementary curriculum framework, the design development and coordination of delivery of an elementary teacher training course, sourcing of external assistance for elementary infrastructure, design and development of elementary handbooks for boards of management and head teachers and the provision of planning and professional services for the maintenance of standards.
EDUCATION REFORM AND SECONDARY EDUCATION
The National Government has approved the education reform and has given instructions to the Department of Education to formulate plans for the effective implementation of the reform policy. Since the introduction of the education reform in selected schools, public confidence in the national education system has grown and many provinces want to participate.
The government's education reforms plan an increase in access to the secondary level of education, from grades 9 to 12. This restructuring relocates grade 7 and 8 from the present high schools to the primary schools, and then using these facilities for extra grade 9 and 10 classes.
The schools selected for grade 11 and 12 classes will be substantially upgraded to provide the facilities necessary for this level of education.
The draft national education plan being developed also includes the development of the vocational school system within the lower secondary level where a range of trade and academic skills will be made available.
The government's vision is to upgrade the general education level of the population through greatly increased access to secondary education. At the primary level of education the government intends to provide access for all children to complete a course of basic education to grade 8.
These changes will then allow a progressive increase in access of grade 8 leavers to secondary education where courses will be available for grade 9 and 10, and for grade 11 and 12. Government objectives at this level of education includes achieving a 50% transition rate between primary and secondary education; that is to double access to grades 9 and 10, achieving a transition rate of 25% between grades 10 and 11, and to thereby increase access to grades 11 and 12 to 5000 per annum, increasing female participation in secondary education to 50%, and providing a broader curriculum in secondary education establishing at least one school in each province to offer grades 11 and 12 by the year 2004.
The forthcoming draft National Education Plan to be considered by Government later this month provides the basis for this to happen through the development of implementation plans at provincial and district levels.
To conclude I wish to thank you for being here today learning something about the education reform and how youths could benefit. The youths are a very special group of people with special needs. From their childhood parents have a very important responsibility of feeding, clothing, sheltering, and educating them. Schools, the governments and non governmental organisations with their technical expertise or financial resources should make their services more readily available for the development of constructive youth educational programmes.
The Department of Education is doing its best to help our youths by planning for expansion of access to secondary schools which will also increase access to universities and colleges, and the private sector.
The family and community located in urban or rural areas, suburb, village or settlement must have a caring attitude towards the education of young people at the secondary level and vocational centres. The years of adolescence and young childhood are often difficult and challenging times for personal development. The youths in school could be assisted under the education reform. But what can we do to assist youths outside the formal education system?
A strong interest in the studies of young students will greatly assist in formulating policies for effective youth developments.
PLANNING TO SAVE LIVES
Firstly let me thank you for allowing me to brief and inform you all of the initiatives the Department of Health has taken to implement the reforms and to provide an overview on the new Health Policy - Reforms for the future now translated into a five year plan of action beginning in 1996 to the year 2000.
As you are aware, cabinet approved the new Health Policy and the 1996 - 2000 National Health Plan on the 29 May of this year, which was launched on the 3rd of June by the Prime Minister.
THE PROCESS OF PLANNING :
The process used to develop the new policy and the 1996 - 2000 National Health Plan was consultative process, drawing the accumulated experience and knowledge of 70 experts from the medical profession itself, from churches, from non government organisations, from donor agencies, from the private sector, from women's groups and from union movements. Much practical experience and local knowledge was drawn from the provinces through all the Assistant Health Secretaries who participated fully during the development stage.
THE NATIONAL DIRECTION
I must say that the recommended national priorities, objectives, targets and strategies contained in the new health plan have not only a strong but legitimate footing. They have been drawn from notable improvements in our national health information system which have been updated to 1994. This included statistical analysis of the local population, local disease trends, and the health status of the population, by district, in particular that of women and children and the extent of health service coverage by key programmes nationwide.
This policy direction has only one goal, and that is "to improve the Health of Papua new Guineans". This must also be the only goal for all levels of government including urban authorities. The distinctive feature of this new plan, which is our country's fourth, since independence, is that there shall be only one health plan. This one plan and its set of priorities are for the nation, for the provinces and for the districts.
There will no longer be 20 different individual provincial health plans, with 20 different sets of policy priorities. This plan embraces a national view of the health problems of this nation, with a broad national battle plan to address and to remedy the current crisis in the national health system.
This approach demands that provinces therefore will develop implementation plans to meet the expectation of the national health plan. This does not preclude the setting of local priorities. The plan is designed to facilitate the translation of national priorities into local action, but within the limits of local resources and priorities, determined locally, in line with local health trends, indicators and deliver systems and constraints.
BASIS OF THE PLAN
The current health situation in the country, which provoked the new health policy and the new health plan cannot be accepted by any well meaning individual or government. The new policy and the five year plan has been designed to address and remedy a crisis in the national health system, and indeed the sad realities of the poor health of our people.
PNG Health Status
The Health Status indicators of our people have been depressing for several years. While there were definite improvements from the early seventies through to mid 1980's, many of our health indicators have since either remained stagnant or have deteriorated. I believe you all are well aware of the nation's health situation; however; may I be allowed to highlight some of the statistical facts regarding the key health indicators.
Infant Mortality Rate (Deaths Under One Year Olds)
Firstly, the infant mortality rate which is the prime health indicator. In 1971 there were 134 infants dying before their first birthday for every 1000 live births. By 1980 this dropped dramatically to 72 deaths for every 1000 infants; however, by 1994, this had actually climbed back to 83 deaths per 1000.
The reason why infant mortality rate is the internationally accepted prime health indicator, is because, it does depict the health status and the economic status of the mother and the community. To illustrate this further, by comparison, the infant mortality rate of the least developing countries averages 111/1000; while the rate for developing countries is 69/1000. In East Asia and the Pacific, the rate is 42/1000. Our rate of 83/1000 in 1994, is the worst in the Pacific. If we look at the range, the picture is much more grimmer, in the Gulf Province, which has the worst rate of infant mortality, it is; 111/1000, while Manus has the lowest with only 40/1000. At this range therefore; between 20 to 50 babies die every day in our country. This totals 600 - 1500 babies dying every month. That is between 7,000 - 18,000 infants dying every year, before they reach their birthday. These are very shameful figures.
The reasons for this unacceptable high rate are the poor health of the mother, resulting in smaller babies being born; therefore more susceptible to illnesses. Low immunisation rates, led to infants dying of vaccinable, and preventable diseases. Others include pneumonia, other chest conditions; malaria, meningitis, and malnutrition. All of these diseases are easily treatable if services are easily accessible to the bulk of our rural communities.
Childhood Mortality Rates (Deaths in 1-5 Year Olds)
From our children between 1-5 years of age, the death rate was 79/1000 in 1971. This improved to 42/1000 in 1980. Then dropped marginally to 40/1000 in 1994. On an annual basis 13,000 or 1 in 8 of our children below 5 years of age die before their fifth birthday.
Maternal Mortality Rate (Deaths in Mothers Dying During Child Birth)
For our mothers, 9 of them will die during child birth for every 1000 child births. The range in PNG is between 2/1000 in urban areas compared to 20/1000 in rural areas. Unsupervised deliveries is the major contributor, resulting in our mothers dying from excessive blood loss during delivery and infection soon after birth. Both of these causes of death are easily preventable and treatable. This very high death rate of Papua New Guinea mothers makes Papua New Guinea the worst in the Western Pacific Region and worse than Lao Peoples Democratic Republic; which has the highest infant mortality rate of 118/1000 live births.
At the rate of 9 material deaths for every 1000 deliveries, PNG looses 1,3000 women every year. Studies have also shown that the death of a mother has always been accompanied by the death of half her children within five years.
Overall, these key health indicators have proven that despite scientific advancement and the economic progress of our nation, the notable initial progress made between 1971 and the 1980's have not been sustained.
During the periods of 1971 and 1985, there was more focus, better coordination, more political commitment and better management of the National Health System. The government's eight point plan, immediately after independence was the basis for a strong political commitment. These concerted efforts brought about much improvements with 50% reductions in our high death rates and an increase in the average life expectancy from 40.9 years to 52 years.
Other Health Indicators (Disease Trends)
Further to this; poor nutrition amongst our children below 5 years of age still remains a major problem. 40 of every 100 children in this country are not receiving adequate nutrition. This nation ranks lowest in the Pacific region. We are also loosing the battle against diseases we suffer from most. These include pneumonia, malaria, diarrhoea diseases, TB, sexually transmitted diseases and HIV-AIDS. With regards to HIV/AIDS, we are now sitting on a time bomb, very much similar in nature to many countries that ignored the emergence of this killer disease. These nations are paying the price of ignorance. They are now socially, economically and politically devastated.
The first case of HIV infection was detected in 1987. Between 1987 and 30 June 1996. There are now a total of 453 cases detected over only 8 years. Papua New Guinea is detecting cases at a rate similar to some of the African and Asian Countries. This is truly a very dangerous trend with major socio-economic impacts on our young nation.
Health Services Delivery and Coverage by Facility
With regards to health services delivery and the population coverage by health services and programmes, PNG has been hailed by the World Health Organisation as having one of the best national health systems. With its Aid post coverage of villages, health centres and clinics and the hospital network at every provincial headquarters, PNG has what can be a reliable health service network. While we have such a wonderful system we have not been able to fully benefit from it. We have had major problems of health services delivery, due to varying reasons including, under funding, inefficiency and ineffectiveness in the National Health Care System.
Church Health Services
Given the lack of adequate support from Government and therefore constraints upon providers of health care, I must acknowledge the particular efforts of the church health agencies. With their limited resources, churches have been most supportive. Currently churches provide 45% of the total health services and 49% of the rural health services including 80% of the community health worker and general nurse training institutions.
Churches in this nation must be recognised, acknowledged and supported by all levels of government for the important role they have been and are, playing in the development of this nation. The department wishes to acknowledge the contribution made in the health sector by churches, including the non government organisations, over the last 21 years.
Current Status of Health Delivery
The status of the National Health Delivery System is that to date, PNG has a total of 2,399 aid posts, 199 health centres, 303 health subcentres, 45 urban clinics and 19 hospitals. Of these, as I mentioned earlier, churches provide 45% of the total services, including 49% of the total rural health services. In 10 provinces churches provide more than 50% of the rural health services.
Rural Health Facilities Status
For Rural Health Facilities, in particular health centres and aid posts, 2% of them do not have water; 30% do not have any form of power, 46% do not have transport; 41% of them do not have radios, 14% do not have fridges, and 67% of them have not had doctor visit; and across the nation 22% of aid posts have closed down. Our bed coverage of 3.9 beds/1000 population is more than sufficient, in comparison to that of our neighbours.
The Health Workforce :
For the Health Workforce there is a total of 11,739 health workers in the country. 35% of the total workforce is based in our hospitals, totalling 4,150; while 47% are based in health centres, and 18% based in aid posts. This means that a total of 65% of the total health workforce is rural based. I am happy to say that this is consistent with the reform direction.
Moving on to key categories of health workers, we have 6.4 doctors for every 100,000 population. As the Prime Minister announced during the launching of the plan on the 3rd of June, this puts us in the "same low league as Bangladesh and Nepal". Two of the poorest countries in the world, but also way behind our nearest neighbour - Fiji.
Overall, PNG has a health worker; population coverage of 49 health workers for every 100,000 population. We must double this over the next 10-15 years if we are to provide an acceptable level of coverage.
National Health Coverage, By Province :
With regards coverage by important health programmes, only 31% of deliveries in this nation are supervised. This is contributing to the unacceptable high maternal mortality rate of 9.2/100 deliveries. The safe level of coverage is 50% or more, which will be the national target over the next five years. This will equal the coverage by other developing nations worldwide.
The national average immunisation coverage for the two vital vaccinations, namely whooping cough and measles is 59% and 35% respectively. The national target will be 80% coverage, which will be at par with other developing countries and at the level which is acceptable by the world health organisation.
In terms of finance resources for health over the years, total health expenditures has been approximately K160 million per year with variations of plus to minus 20%. Of the K160 million, K100 million has been for national expenditures, K46 million for provincial expenditures, that is prior to 1996, and K12 million from donor and loan funds under the public investment programme.
Although levels of expenditure have increased, they have not increased as rapidly as that of total government expenditure. As a result, health care spending has declined from 10% to 8.1% of total government expenditure between 1985 - 1995. On a per capita basis, urban residents receive three (3) times more health expenditure than rural residents. Over the periods 1993 - 1995, rural expenditures have shown as 3% decline.
Further important changes in percentage allocation over the years have been increases in curative and preventive budget in urban areas. Medical supplies budget however declined for both areas. For provincial divisions of health and hospitals; 80% of the budget are allocated for personnel emoluments, leaving a mere 20% for goods and services.
In comparison with our similar socio-economic level counterparts on the world level, PNG spends 2.7% of GDP on health, compared to 4.7% by similar demographically developing countries. PNG spends US$41.00 per capita by similar demographically developing countries. Of course these levels of health expenditure, are only half the total picture of why the nations health system and the people's health indicators are in a crisis today.
In launching the health plan, the Prime Minister correctly stated and I quote "these problems we have now; have not always been due to a lack of funds nor are they due to a shortfall in dedication on the part of the vast majority of our health workers... What has been lacking perhaps has been the correct levels of coordination, between the national government and the provincial government systems ... All of us collectively, as leaders share in the collective guilt" .. End of quote.
THE NEW DIRECTION
I hope, you are as convinced as I am that a new vision, and direction is now urgently required to address this national crisis. In this regard, the government has now got in place a policy direction, translated into a medium term action plan to address this crisis. The government has also adopted an ambitious plan, which is the blue print for revitalising our National Health System, and also a stepping stone for sustaining health improvements beyond the year 2000.
THE DIRECTION OF THE PLAN
It is now my humble duty to inform this distinguished gathering of the direction of the health reforms as contained in the new plan. The plan incorporates the direction of the new policy and has taken into consideration experiences and shortfalls of the last 5 years plan, including the poor state of our health indicators and the current crisis affecting the National Health System. It is also designed to meet the direction of the constitutional reforms under the new organic law, that has changed the roles and responsibilities of government at all levels.
In order to address the current crisis, the government has provided the direction for the country to adopt only one national health plan, which will be translated into provincial and district level action or implementation plans. As I had earlier highlighted, this will not preclude the concept of bottom-up planning at the local level, which is key to the success of this plan.
Provinces and districts will consider local priorities, but be guided by the overall national policy priorities and national targets. Planning, programme development and budgeting will remain the responsibility of districts. This is were implementation will take place.
The new health plan has five key policy priority areas : the priorities are to :-
To implement this policy direction, emphasis will be placed on the following areas for reform.
A Shifting emphasis from urban to rural and from curative to promotive and preventive health :-
This has always been the policy of the last three years National Health Plans and also that of previous governments. However, the problem has been poor role definition and clarity in the devolution of powers and responsibilities with regards to different health programmes. For the first time however, this ambiguity has now been resolved by the new organic law on provincial and local level governments.
Consistent with section (42.N) of the Organic Law, provincial government are now responsible for rural health services. The department has now defined rural health as those curative, promotive and preventive health services, outside of a designated and declared public hospital. Under this definition, all public hospitals are a national function, as established under the public hospital act of 1994. All rural hospitals, health centres, clinics and aid posts are the responsibility of provincial governments.
To achieve the goal of increasing services to the rural majority and to address the appalling poor state of the health of rural women and children, the national department together with provincial health authorities have devised key programmes for implementation at the provincial and district levels, consistent with the definition of rural health.
If funded and implementation, these programmes will improve the health status of our people and therefore achieve the goal of the plan.
The key programmes, which must receive budget support at the provincial and district levels include :-
Family Health Services :
This programme will ensure that health patrols are carried out, in particular to the more isolated rural communities. A minimum of 4 patrols will be made every year by each district. Immunisation will be provided at every opportunity, and coverage will be expanded. Safe motherhood and safe delivery services will be expanded. The village birth attendance programme now piloted in selected provinces will be extended to other provinces. Family planning will be emphasised to safeguard the health of the mother and the child. Nutrition for under 5 year olds will be promoted and improved.
Health Promotion and Health Prevention :
Here, the 10 leading causes of sickness and death will be given particular emphasis. Media will be fully utilised, in particular the radio network.
Disease Control :
The control of malaria, TB, diarrhoeal disease, childhood chest diseases, STD/HIV and Aids will be given particular attention with improved control programmes and better treatment services.
Water and Sanitation :
Rural water supply and environmental hygiene programmes will be expanded. In particular rural water supply and proper disposal of human and industrial waste.
Facility and Equipment Maintenance :
Much of health facility and equipment requires adequate upgrading and maintenance, in particular the life saving equipment. A programme of equipment maintenance has been developed and will be supported by an AusAID funded project.
Hospital Support for Rural Health Services and Staff :
Hospitals will make an undertaking through agreements between them and rural health services to provide the necessary support. To do this effectively hospital will place emphasis on improving their management and operational skills. Regular supervision and in service training of rural health workers (including urban workers too), to improve their clinical skills will be undertaken by all hospitals. The policy on rural hospitals will be implemented to upgrade two health centres per province to rural hospital status. This will bring specialist services closer to where our people live. Funding for this policy is being negotiated.
B) Undertaking Financial Reforms :
The second area is the undertaking of financial reforms. The plan has, for the first time, made it transparent to increase resources to rural health and promotive and preventive health services. This has been done by identifying key programmes known to improve health, including resource allocation, and implementation, particularly at the district level.
The department has also devised a standard health budget and a standard finance reporting system to monitor the level of resources allocated to the key programmes.
User fees for hospital and dental charges have been reviewed and implemented since July of 1995. Indications so far has been very encouraging as hospitals are now able to improve their revenue. User fees for rural health services will be addressed initially through a feasibility study to assess whether they could be introduced, and at what rate. Under the reform process and the structural adjustment programme (SAP) requirement, resource allocation proportions for salaries and goods and services has been reviewed and improved. This will ensure that adequate funds are available for goods and services, and not used up in salaries and wages alone.
C) Improving Health Services Delivery :
The final area of reform directions is to improve health service delivery. This is where the reorganisation and restructuring of priority areas comes in. Under the reforms, the department has developed model district and provincial health administrative structures, to improve organisational efficiency for service delivery. The top structure of the department has been approved by the Department of Personnel Management with emphasis on shifting technical manpower to provinces and districts.
In order to ensure that the total health reform direction is picked up at the three levels of government, the Department has completed the drafting instructions for the new National Health Administration Act. The main trust of this proposal is to establish a national health board; provincial and district health boards to oversee policy development and implementation.
This new act will legitimise the development of linkages between hospitals and rural health services to ensure that hospitals support health services. Together with these changes; hospitals are also being restructured, with the establishment of hospital boards, and the redefinition of different levels of hospitals and their functions. This exercise will streamline hospital functions, make them autonomous; more accountable and to contain their recurrent costs.
The department is also developing a framework to rationalise the pre-service training institutions, with the aim of transferring this function to the commission for higher education. This will allow the department to concentrate on in service training and professional development of its workforce. To facilitate this initiative, the two human resource development projects; one funded by AusAID and another by ADB will help the department to complete this institutional reform I am pleased to announce that the AusAID funded project now been implemented will provided support to specialist services and manpower development.
This project which is worth A$13.4 million will help to strengthen the capacity of the department and the university to plan for and provide improved teaching of doctors, nurses, and allied health professionals. Specialist training for doctors, nurses and allied health workers will also be provided to ensure that our doctors have the skills necessary to handle the majority of conditions our people suffer from. This will prevent Papua New Guineans from seeking medical attention, overseas.
Today, Papua New Guinean doctors have the skills on eye and bone surgery and able to diagnose heart conditions and skills to operate on the majority of these conditions.
The ADB funded human resource development project will be implemented in October this year, with particular attention for the in service training of rural health workers and the institutional strengthening of pre-service training institutions for health extension officers, health inspectors, nurses and community health workers.
Both of these projects will contribute to improving the workforce planning, training and management capacity of the department of health.
The Government has now made a commitment to provide a proportion of fully funded training slots, on an annual basis for the health sector, to boost the total health workforce in the country. In the interim period the department of health will negotiate with volunteer service organisations to provide doctors to fill all approved funded and vacant positions.
The church health services under the reform is by definition part of rural health services, therefore support for church health services will be provided by provincial and district level authorities. This implies that agreements must be developed between the authorities and church organisations to incorporate church health services into the district health services programmes. The National Executive Council (NEC) has given the approval and direction to have the salaries of church health workers incorporated into the provincial payroll system.
Together with these structural changes; the maintenance programme of health related services and training facilities and the introduction nationwide of the radio-communication network now piloted in Madang and Milne Bay Provinces will help to boost staff morale, remove isolation and improve confidence in the National Health System.
Together with these initiatives, now outlined in the new plan; other areas of focus and attention will be :
National Health Information, Monitoring and Health Research.
In the area of Pharmaceutical Services, priority will be given to improve the management and operations of the Pharmaceutical Services. This will include the privatization of the distribution of medical supplies in the country; improve inventory control systems; provide management and technical training of staff, and improve delivery of drugs to the rural services.
For the National Health Information System, much work has already been done so far to improve the information system. This is reflected in volume two of the plan, which contains all the technical data. Included in the last section of this paper is data for open electorates, their population of age, the number of health facilities, and the state of these facilities, including their staff numbers and categories. This will provide useful data and information for the respective district planning committees in each district.
The private sector will also be required to report to the National Health Information System.
This information will be used to monitor the implementation, by district, of the new health plan. In the area of health research, PNG is in the forefront of some important scientific research which have been undertaken in this country. Notable of these are the pneumonia vaccine, pig-bel vaccine and the malaria vaccine, which is now in trial in the country. Emphasis will now be placed on health systems research over the next 5 years.
Now that the government has established a clear policy direction and a medium term plan, I must say that donors are now more confident and have shown great interest in investing in the health sector. Together with donor agencies, the department has developed projects worth approximately A$130 million, with AusAID. Negotiations are now underway with the Asian Development Bank for a programme based loan worth approximately US$45 million to support rural health programmes over the next 5 years. Details of these projects will be announced as and when they are approved and implemented.
HEALTH PLAN IMPLEMENTATION AND MONITORING
As highlighted earlier, implementation of the plan will be at the district level. The plan has a national focus, but has sufficient flexibility to be operationalised at the local level. As per the spirit of the reform, programme planning and budgeting will be at the local level, however, we do have a national crisis therefore, national priorities have been set, which must be implemented at all levels of government, together with national targets which must be reached by the year 2000.
A monitoring system has been established to monitor implementation, and to ensure that progress is achieved. To facilitate this initiative; the 5 key programmes, earmarked for district and provincial level implementation, will form the basis for monitoring. To this effect, a performance assessment proforma has been developed. This proforma, encapsulates two levels of indicators; one for national indicators and the other for both the provincial and district indicators. Indicators for national level are focused on policy areas and standards, while indicators for provincial and district level concentrate on service delivery.
For each district, performance will be assessed annually. A scoring system will be applied and districts will be assessed. Based on this scoring system, each district will be graded as :
Using this assessment system, we will be in a better position to know our health situation, give the reasons for failing and recommend ways for improvements.
As has been mentioned, this plan has only one goal, that goal is to improve the health of our people. The plan, as most other plans do, does not seek a big increase in additional resources. Rather, it is oriented at propelling efficiency and effectiveness of the National Health System, including capacity building, consolidation and maximising the productivity of the workforce in the system. It is; in my humblest opinion a very practical and achievable plan; which is not beyond realisation, not for any other reason, but for the sake of all of us, Papua New Guineans.
Our task, as the Prime Minister has stated, and I quote; "Is to implement all the strategies, and to faithfully follow all the priorities the plan contains", end of quote.&NBSP; In launching the plan, the Rt. Hon. Sir Julius Chan, gave the government's commitment, freely and unequivocally to ensure that this plan achieves what it sets out to do; that is , "to save the greatest number of lives, and to improve the health of the greatest number of our people.
I make the strongest plea, for us all to support the commitment given by the Prime Minister and his government. In my view, political support, of the highest nature, is key to the success of this plan. I believe our people, in particular the rural majority, specifically the mothers and children deserve our undivided support and commitment.
Achievements can be expected if we all make the commitment today to ensure that the plan is implemented at all levels of government. With that I thank you for allowing me to inform you all of the undertakings of the Department of Health in implementing the reforms, and in setting a new direction for the development of Health Services for Papua New Guinea towards the year 2000 and beyond.
ANNEX - YOUTH AND HEALTH REFORMS
According to 1990 Census data, the youth, between 10 and 25 make up 31% of our population. Approximately 28% of them were in school. We are taking about a large percentage of our people that can be mobilised to turn this downward trend to our advantage. Our youth needs to take the lead in campaigning for health over the life of the National Health Plan and beyond.
The Health Department cannot do the job alone. The youth being the educated part of the community must organise and support health services in promoting health in the community they live. My appeal here is part of the Department's approach to improve the health of our people.
The health of our people, particularly the mothers and children are unacceptably high. There is a lot the National Youth Service can do towards promoting good health. The things the youth can do includes :-
These are new suggestions but more the National Youth Movement is health conscious and become active agent for improving the health of our people, the health reforms and the policy initiatives will become a reality. All youth, regardless of their background and belief, has the potential to turn the unacceptable situation of the health of our people to something to celebrate in the year 2001.
GEORGE H. WRONDIMI, Conference Facilitator
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