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Leadership and Accountability: Driving Effective Infection Prevention in Papua New Guinea’s Health System

According to the World Health Organization, leadership, governance, and accountability comprise the cornerstone building blocks of any health system. These elements are not just fundamental to enhancing the system’s functionality, but also to improving people’s access to health services. Viewed as cross-cutting aspects, leadership and governance set the foundation for the remaining components of the health system. These include financing, workforce development, medicine and medical technologies, and services, among others. These elements also necessitate coordination across all tiers of the health system, allowing for efficient management and performance enhancement.

However, Papua New Guinea’s health systems face significant obstacles in governance, leadership, and accountability at subnational levels, particularly at the Provincial Health Authority (PHA) level, despite the implementation of ambitious policies and reforms by prior governing bodies. A survey concerning the execution of tuberculosis (TB) infection prevention and control policy in Papua New Guinea’s Highlands and Momase regions illustrates this problem. The results showed that while 80% of district hospitals had plans for TB infection prevention and control, there was no specific budget allocation for actual implementation.

Further commentary from health workers, facility managers, and district health managers identified funding deficiencies for community awareness programs and health education initiatives concentrated on TB. Fund distribution for rural health services comes via PHAs, requiring PHA leadership approval. Lack of robust governance and leadership at the PHA level resulted in inadequate funding for delivering healthcare services in remote districts. The research further found a strong association between solid leadership, governance, and accountability at the PHA level, and availability of funds at the district level.

The study also underscores the importance of accountability in leadership. It is a key factor in promoting coordination among teams towards shared goals, encouraging effective management of TB. Accountability among leaders can foster trust in leadership, which can lead to improved performance. It could quicken the pace of innovation among healthcare workers, which can bring about better implementation outcomes in the long term for TB infection prevention and control policy.

Regrettably, many healthcare institutions in the districts lack the capabilities to roll out TB infection prevention and control programs. Various aspects, including the long-standing shortage of healthcare workers, absence of medical technologies and drugs, insufficient funding for TB infection prevention and control programs, and poor healthcare infrastructure contribute to these limited institutional capacities. Strengthening these institutions’ capacity requires resolute leadership, administrative assistance, and long-term planning and investments to implement chief public health policies.

TB is an intricate public health issue, with the remedy lying in partnerships between Papua New Guinea health authorities and other relevant parties, such as development partners, non-government organizations, and Christian Health Services. Yet, the ongoing underfunding of healthcare within rural primary healthcare settings in Papua New Guinea is worrisome, with PHA leadership, governance, and accountability as part of the problem. This lingering problem significantly hinders the effective implementation of TB control policies and programs. The need for collective effort among all relevant entities to uphold the objectives of Papua New Guinea’s TB control policies is more critical than ever.


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