Hospital for the rich

Peter Barter
Former Health Minister

At the risk of being accused of post-political interference, I cannot allow the development of the proposed so called “World Class Hospital” in the Central Province without challenging the absurdity of such a development when the entire health system throughout PNG is in dire straits, especially the existing provincial hospitals including the Port Moresby General Hospital.

As the former Minister, albeit for a very short period, I worked hard for the Government to release funds to maintain existing health infrastructure from the two Supplementary Budgets. Initially we expected to have a total of K300 million released. This was eroded down to K187 million and out of those funds only a fraction was released on scoped projects that included major maintenance of operating theatres, redevelopment and urgent maintenance of Angau, Port Moresby, Madang, Wewak, Goroka, Mt Hagen, Kerema, Wabag and Wapendamanda, Bruan, Etep, Gaubin plus scores of health centres, nurses housing and purchases of equipment that was required for our doctors to perform their functions. Had these funds been released and funds spent as intended we would have seen a marked improvement in both staff morale and health services to the people.

We also took several trips to Cuba in an effort to secure Cuban doctors, not to replace PNG doctors but to recruit “rural doctors” who were prepared to live in rural areas and improve the level of health services with minimal equipment and infastructure. The offer by the Cuban Government was not only to provide doctors, but to also help us train doctors and nurses and at the same time we had intended to expand the medical faculty of the UPNG and develop a faculty at DWU in partnership with the churches to train “PNG Rural Doctors” which would ultimately replace the Cuban doctors.
I recognised that it would be difficult to bring in hundreds of Cubans, what we had in mind was to bring in say 50 and allow the Church Health Services to use the doctors as the churches remain the major health provider in rural areas and they had accommodation available and the willingness to improve their services.

The third element was to implement the Health Administration Act which was passed by Parliament to establish provincial health boards that would allow hospitals to expand their work into the rural areas, allow doctors to move out into the health centres, treat and train health staff, provide in-service training and to avoid the duplications that had wasted a lot of money, allowing maximum effort for the little funds available. Another element which has not been implemented was the Church Health Act that was to replace the Church Medical Council, enabling the churches to be more independent to raise their own funds, develop and expand health facilities themselves rather than be totally subservient to the national and provincial governments.

Having said that, it was made quite clear that they would work in partnership with the Government.
This increased power would enable them to improve the delivery of health services but at the same time be required to work within the policies of the Department of Health. The pros and cons can be debated, but in the end, it is only right that the churches stand on their own two feet so they can sustain and expand the services they have provided so well in the past. The failure of the MVIL Hospital was largely related to the lack of workable health insurance in PNG and even now, there are not sufficient people formally applied that would make a super private hospital viable.
Even if a health insurance scheme was introduced now most people in PNG would not be covered, in other words, the hospital would serve the rich and leave the vulnerable poorer people at the mercy of the existing health system.

I fully support the establishment of good hospitals in Central and Kerema, I support the expansion of the Port Moresby General Hospital and other hospitals to provide more specialists and medical equipment so we can treat various medical conditions such as cancer, diabetes, intervascular, urology, even brain surgery and to achieve this the Government will need to allocate hundreds of millions over a period of time and perhaps at the same time introduce a ‘bonding or contracting” scheme to keep trained doctors in the public health system.Interesting comparisons can be made of the level of funding by the Australian and Queensland Government on Aborigines in North Queensland which exceeds the total cost of what our Government spends on our population of more than six million. Unless more money is invested into health in PNG the bulk of the population will continue to suffer and many people will die needlessly. Like education, health is equally important and before we consider building a hospital of “excellence” we should first begin by supporting the existing health structure to ensure we can reduce the mortality rates of infants and women which are among the worst in the world.

I have met those people from the USA who visited PNG to support the Hospital of Excellence. My feeling after the meeting was they were not all convinced that the proposal for a Super Hospital or hospital of excellence was the answer to our immediate problems. They largely supported the views expressed by myself and those who attended the meeting in Madang. How can we begin to talk about this proposal in light of the state of existing hospitals that serve the bulk of the population, how can a handful of doctors and nurses in the public health system cope with delivery of an acceptable level of health services given the geographical diversity and difficulty of transport and super impose an expensive super hospital for the lucky few that may be insured or can afford such specialist treatment in or out of PNG.