SUPPORTING EVIDENCE TO THE ARREST PLAN 2013 -2016

Theme: “GETTING THE BASICS RIGHT:”

National Department of Health

August, 2013

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TABLE OF CONTENTS

Pages

Acknowledgements 2

Acronyms 3

Tables in the document 5

Figures of the Graphs & Diagrams 5

Introduction 6

Section 1: Background7

Section 2: Policy &Legal8

Section 3: Current Health Workforce9

Section 4: Current Christian Health Services22

Section 5: Training Responsibilities32

Section 6: Training Programs and Training Issues36

Section 7: Training Institutions40

Section 8: Costing48

Section 9: Concluding Remarks51 ATTACHMENTS: Data and Information Sources53 These Attachments and information (Policy, Reports, Submissions) provided by various stakeholders to complete the Arrest Plan 2013 -2016

i. Human Resource Management Policy of NDoH ii. Professional Medical Standards

iii. Medical Standards iv. World Bank Report – Health Workforce Crisis “A Call to Action” October 2011 v. Access Status of Health Facility Services – PNG

vi. Training Policies for Vacancies for various cadre of Medical Officers (2014 and beyond):- By the Medical Board of PNG

vii. CHWs Schools Diagnostics Audit 2012

viii. PNG Capacity Nursing Schools Diagnostics Audit ix. Templates used to collect information from Hospitals, Institutions & PHA x. Health Workforce Plan Workshop xi. Baseline Data Report 2009 /2010 xii. Regulatory Authorities xiii. National Health Plan 2011 – 2020 xiv. Terms of Reference

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ACKNOWLEDGEMENT

The Health Workforce Plan Team Secretariat‟s wish to place on record their

appreciation to various branches of the National Department of Health, Principles of

Training Schools and Colleges, the Universities, Provincial Health Administrations,

the World Bank Report 2009,the Diagnostics Reviews on CHWs and Nurses under with

AusAID Support and from many individuals who provided very important data and

information, and of which many of these data have been accommodated in this

document to support the Arrest Plan 2013 - 2016.

Much of the data and information captured in this document argue the case for

supporting the „Arrest Plan‟ and for the government and the National Department of

Health to pay special attention to the Health Workforce challenges that must be

addressed immediately and, as well, over the long -term to arrest the current

workforce crisis that is looming in the Sector.

This report made some Manpower projections and predictions based on the

information provided to us.

We wish to acknowledge the Medical Board of PNG, the National Nurses Association

of PNG, and the Christian Health Services for their contributions to the Health

Workforce present status and therecommendation we have gladly included as part of

this Supporting Document.

On this same note, we thank the WHO Office in PNG, World Bank, Australian

Government (AUSAID) and other Multi -lateral and Bilateral Donors and Agencies for

their continuing support to the Ministry of Health and the people of Papua New

Guinea.

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ACRONYMNS

AHW Allied Health Worker AusAID Australian Aid International Development CHA Church Health Agencies CHP Community Health Post CHS Christian Health Services CHW Community Health Worker CPD Continuing professional Development DGN Diploma General Nursing DISC District In-Service Coordinator DPM Department of Personal Management DPs Development Partners DSIP District Service Implementation Program DWU Divine Word University FBO Faith Based Organizations GoPNG Government of Papua New Guinea HCAC Health Curriculum Advisory Committee HDI Human Development Index HEO Health Extension Officer HSHRP Health Sector Human Resource Policy HSM Health Sector Management HSMS Health Service Minimum Standards HSS Health Support Staff ICP Information and Communication Program ICT Information and Communication Technology LLG Local Level Government LLGOL Local Level Government Organic Law MDG Millennium Development Goal MO Medical Officers MSF Medical Service Frontiers (Doctors without Borders) MTDP Medium Term Development Plan MTDS Medium Term Development Strategy NDOH National Department of Health NEC National Executive Council NGOs Non-Government Organizations NHA National Health Administration NHP National Health Plan NHP National Health Policy NHS National Health System NHSS National Health Service Standards NO Nursing Officers NPO National Planning Office NPSGO National Public Service General Orders NZAID New Zealand Aid International Development OHE Office of Higher Education OLPLLG Organic law Provincial and Local Level Government PAU Pacific Adventist University PGA Public Grants Allocation

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PHA Provincial Health Administration PHC Primary Health Care PLLG Provincial & Local level Government PNG Papua New Guinea PNGUOT Papua New Guinea University of Technology PPPP Public Private Partnership Policy PSMA Public Service Management Act RHEO Residency Health Extension Officers RHEP Rural Health Extension Program RMO Resident Medical Officer SAP Structural Adjustment Programs SOMHS School of Medicine and Health Sciences SON School of Nursing SPC Secretariat of the Pacific Commission TB Tuberculosis UN United Nation UOG University of Goroka UPNG University of Papua New Guinea VBA Village Birth Attendance VHV Village Health Volunteer WB World Bank WBR World Bank Report W.H.O World Health Organization YWAM Youth WithA Mission

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TABLES

Table 1 Number of Health Facilities by Government and Agencies

Table 2 Summary of Primary Health Care Service Facility GAP Analysis by

Provinces

Table 3 Total Public Financed Service –Delivery Staff by Gender & Occupation

Table 4 Indicates the number of health personnel serving in private health

facilities in the country by Province

Table 5 Number of Health Workers in Private Health Facilities

Table 6 Total National Hospital Manpower Summary by Facility by Region

Table 7 Christine Health Service Agencies by Province

Table 8 Summary of CHS Provincial Facilities in the country

Table 9 Summary of Training manpower

Table 10 Providers of Pre-Service and Undergraduate Programs

Table 11 CHW Schools in PNG

Table 12 School of Nursing by locations, Agency/Provinces and educational

status

Table 13 Providers of Continuing Education and staff development Program

Table 14 CHW Schools Diagnostic Audit 2012

Table 15 Nursing Training Staff and Profile

Table 16 Inventions for Nursing Schools-2013

Table 17 Summary of Training manpower projections under the plan

FIGURES

Figure 1 Analysis of the Current Health Service Delivery Staff at RuralHealth

Facilities and Age Group

Figure 2 Analysis of Current Health Service Delivery Staff at Hospitals /Urban

Centers & Age Group

Figure 3Analysis of the current health service delivery Staff and Age Group

Figure 4 Christian Health Services Organisational Structure.

Figure 5 CHW Cohort Enrolments/Graduates/Attrition 2007-2012

Figure 6 Age Profile of CHW Educators

Figure 7 Nursing Cohort Enrolments/Graduates/Attrition 2006-2012

Figure 8 Age Profile of Nurse Educators

Figure 9 Age comparison between Nurses Vs CHW Age.

Figure 10 Enrolment of MBBS and AHW Programs by UPNG

Figure 11 Enrolments of RHEO by DWU

Figure 12 Summary of the BN, BCN and BCH

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Introduction

ThisSupporting Evidence document provides detailed assessment of the national

health system and points out the challenges within the health workforce. This is

intended to enable the Management; Policy Decision Makers in government, all other

partners and stakeholders of Health consider taking positive steps to avoid the

workforce crisis hanging over us. We believe there is a wealth of information and

data that will guide your decision making processes to resuscitate the health

workforce development for the future good health of the people of Papua New

Guinea.

The document consists of nine (9) sections and a number of important reference

statements from a number of important health services workforce providers.

Section 1 provides a brief background of the need to address the Arrest Plan.

Section 2 provides the policy and legal framework; Section 3 reviews the current

health workforce; Section 4 provide a status report of the Christian Health Services

and the challenges they are experiencing in both the workforce and facilities;

Section 5 highlights training responsibility in the health system; Sections 6 draws

attention to current training programs and discusses issues surrounding training;

Section 7 identifies the health training institutions in the country; Section 8 provide

a summary of the indicative costing of the Arrest Plan for planning purposes and the

last section (Section 9) provide some concluding remarks…

We have as much as possible tried to collect all the relevant information and made

contacts with research institutions, communities and lead authorswith the view to

complete this report and Arrest Plan.

These important data and information collected should enable those responsible

decision-makers/managers in policy formulation and for supporting the

implementation of the „Arrest Plan‟in the Ministry of Health and its partners over

the medium term.

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SECTION 1: BACKGROUND

The „Arrest Plan‟ documentation is presented in two parts: The first part (The Arrest

Plan) addresses the human resource management policy issues and outlines the key

componentsand activities of the Plan; while this second document provides the

„Supporting Evidence to the Arrest Plan‟ and provides statistical Data and

Information on all cadre of the Health Workforce and their current status. This

document examines in some details the health status in the country, province by

province, training institution capacity to take in more students and bring forward

the gaps (shortage of staff) at the hospitals and the current status of Christian

Health Services in the country.

In order to predict and plan for the future of PNG Health workforce development,

the need for quality and reliable data and information are imperative for our

planning and design of our policies that will assist the Department to determine a

„Way Forward‟ in addressing the Health Workforce in the Arrest Plan and especially

managing the shortages of staff for the National Health System.

Our Health Workforce policies and strategies as planned and designed could begin by

accommodating questions such as these: Where have we come from, Where are we

now?Where do you want to go?How will you get there?How do we stay there?

Human Development Index

The measurement of how we are effectively delivering services to our people could

be measured from a number of indices and is a very good yardstick. For our purpose

here, the Human Development Index ( HDI) tool has been embraced in the PNG

Vision 2050 as an important management tool in tracking and measuring success of

the social and economic sectors such as health, education and economic. It is an UN

accepted tool and its data and information intensive exercises in measuring the

success and improvement of quality of life through their programmes and activities

implemented throughout the world district, province, state, or country.

The application of the HDI can be applied as an important reporting, monitoring and

evaluation in ensuring the „Arrest Plan‟ succeeds in both the short and long term.

The HDI provide for a composite measure of three (3)dimensions of human

development:-

i) Living a long and healthy life –measured by life expectancy;

ii) Being educated –measured by adult literacy and enrolment at

primary,secondary and tertiary education; and

iii) Having a decent standard of living –measured by purchasing power parity

and income.

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The application of the HDI is an important indicator for the Health Ministry if

it‟sWork Programmes and especially its workforce is given priority in achieving the

required values (HDI) for comparison and supported by good governance policies and

financial resources.

Reliability of Information

At this stage, the data and information collected from all our partners and authors

are of high quality and accuracy for this assignment.However more time would have

been preferred to collection of data from all facilities as well as from other key

sectors such as education and economic to obtain a realistic understanding of

progress for the country and the Health Ministry success rate in caring for its people.

The Monitoring and Evaluation Principle is an important tool to measure in

trackingdown the human resources capacity and its future growth.

SECTION 2: POLICIES AND LEGISLATION

These are some of the important issues and policies to understand whilst developing

the Arrest Plan and include:

2.1 Health Functions are governed by legislation to ensure compliance and policy to

ensure direction and effective implementation.

2.2 The Health Sector has a number of important legislation that governs the

management and administration of the national health system and should always be

used as references for all we do in the sector.

2.3 The Health Sector Human Resource Policy was timely developed and approved

by the National Executive Council (NEC) in October 2012. This policy provides the

strategic direction for workforce development and complements the Public Service

Management Act 1995, National Public Service General Order 2012, Public Private

Partnership Policy and other health sector policies and legislation. The policy

principles and strategies are intended to address human resource management

issues in the health sector and guide the development of the Health Sector

Workforce Plan. This workforce planning comes at the most critical phases. Firstly

we have a workforce crisis at hand and secondly the Human Resource Policy is now

in place to take appropriate steps to address the workforce challenges.

2.4 In the management and administration of health services delivery, it is

imperative to appreciate the roles of the three tiers system of government with

regard to health functions under the Organic Law on Provincial & Local Level

Governments(1995) legislation. The system shares responsibilities over a function

among a number of authorities. For example, as a general principle, under the

decentralization policy, the National Government is responsible for policy and policy

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standards and resourcing. Provincial Governmentsare responsible for coordinating

the implementing of these national policies, standards and programmes while the

Local –Level Governments are to ensure basic government services are delivered to

the people in the Wards/Villages in their electorates. Thesecomplex arrangements

demand proper understanding of the decentralization system if we are to carry out

our mandate effectively in providing quality basic health care to the community.

The decentralization policy of the government requires all authorities and agencies

working together and no one authority has total jurisdiction over a function. This

same principle is echoed for the implementation of the current National Health Plan

“Health is everybody‟s business”. Health like Education is a decentralised function

and they can improve accessibility and provide quality health care if the government

pay more attention to improving training for their workforce. Administratively the

majority of the health workforce is placed at the sub national level and not only a

more effective management arrangement is needed but effective coordination and

continued consultative measures are critically vital for good governance and

transparency of the health system. When applied to the decision –making processes,

resource allocation, personnel management, clarity of responsibilities, reporting and

feed-back and implementation, the system becomes more accountable for what it

does.

2.5 As mentioned above, Health has two major and importantlegislations: the National Health Administration and Provincial Health Administration. The facilities that come under the National Health Administration include NDoH, Health Standards, Public Hospitals, Human Resource Management including Nursing & CHW Training Schools, and Area Medical Stores. While those facilities that come under the Provincial Health Administration includes Provincial Health Administration Office, District & Rural Hospitals &, Clinics, Health Centres, Sub Centres, Community Health Posts and Aid Posts. 2.6 The Organic Law on Provincial and Local Level Government Act 1995 demarcate and define the roles of the different tiers of health administrations. Further, the Department of Personnel Management has decentralized some of its powers “under devolution of power” to the National Health Administration and Provincial Health Administration. It is important to understand clearly the roles of the National and Provincial Health Administration and that of other health sector partners for effective & efficient implementation of the Health Workforce „Arrest Plan‟.

SECTION 3: CURRENT HEALTH WORKFORCE

This is section provides review on the current workforce for the Health sector and

includes; access to rural and urban, gender and age distribution, roles of rural and

urban facilities and clinics, private sector contribution in the rural and urban clinic

health, staff constrain and summary of the total Human force in the country.

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3.1: Access to Rural& Urban Health Care Facilities

3.1.1 Papua New Guinea has a population of approximately 7 million in 2011 and is

expected to grow at a rate of 3% each year. By 2020 the population is expected to

be about 10 million and if the trends continue, we should expect a population of

about 20 million in 2050, and this is going to pose a major threat in the accessibility

to the primary health care facility for the delivery of basic health care services

unless the National Department of Health and all Provincial Health Administrations

take immediate action to address the gaps now and those that are likely to occur in

the future.

3.1.2 Approximately over 80% (percent) of the people in this country lived in the

rural areas and about less than 20% (percent) living in the urban centres of PNG.

Hence, it is imperative the Health Authorities return to „back to basics‟ and revisit

the fundamental health care services to the people as stated in the National Health

Plan 2011-2020, “Improving primary health care services for rural majority and

urban disadvantage”.

3.1.3 Further, accessibility to primary health care facility is difficult due to

geographical features of PNG. Table 1 summarises the challenges the Health

Department and its partners are performing throughout the country. Our people are

scattered everywhere in coastal villages and islands, along the mountains ridges and

valleys, and along the river banks in the provinces. Majority of the people live out

there and obviously they are the target for the health workforce for providing the

primary health care services for improving the country‟s health indicators in the

country.

Table 1: TotalHealth Service Facilities by Provinces &by Agencies

The Information provided here is total heal facilities by province to alert leaders, government and

management at all level the access to health via the health facilities both nationally and by each

province.

Provinces GHS Facilities

MHS Facilities

OHS Facilities Total Facilities

1 Western 18 22 2 42

2 Gulf 12 11 0 23

3 Central 20 17 2 39

4 NCD 12 1 5 18

5 MBP 16 25 0 41

6 Oro 14 5 0 19

7 SHP 19 22 0 41

8 Hela 14 18 0 32

9 Enga 21 14 1 36

10 WHP 13 16 0 29

11 Jiwaka 14 13 0 27

12 Simbu 23 10 0 33

13 EHP 20 16 0 36

11

14 Morobe 35 6 2 43

15 Madang 33 15 2 50

16 ESP 19 26 0 45

17 WSP 12 25 0 37

18 Manus 9 3 1 13

19 NIP 20 12 1 33

20 ENB 20 12 1 33

21 WNB 15 13 4 32

22 ARB 22 14 1 37

Total 401 316 22 739 Source: NHP 2011 - 2020

Note: Table 1 summarizes the health service facilities in the country that is run by the Government,

Churches, Faith Base Organization and Mining Companies etc. in PNG. However, this summary

excluded the Aid Posts& the Community Health Posts piloted in some provinces as this is shown

separately. The facilitiesreferred above include;Sub Centres, Health Centre, District Hospitals, Urban

Clinics and Provincial Hospitals

A more detailed summary of the health service facilities for each province and the responsible

agenciesaredepicted Table 2 and the Attachment.

3.1.4 Access: GAPS in the provision of basic health services at the Community level

The Table 2shows the sorry and depressing state of the health system in the country and identifies

the health workforce gaps at the Aid Posts, Community Health Centres and District Hospitals that had

closed down over the years and we recommend that they be re-opened to provide health services, to

those that are missing out at this stage.We make an observation that to increase access to cover

more of the population, the Provincial Governmentsshould vigorously plan to open at least five health

facilities a year in their provinces and for the National Department of Health to fast track the roll-out

of „Community Health Posts‟ and „District Hospitals Expansioninto all the 89 Districts in the country

and for other health facilities into the 325 LLGsand Wards, of which most are not covered at the

present time.

Note: The GAPSin the provision of basic health facilities we mentioned above are further highlighted

in more detailed in the Table 2 below:

Table 2: Summary: Primary Health Care Service Facility GAP Analysisby Provinces

PROVINCES Aid Posts Sub Health Centers Health Centers

District Hospitals

No. of Wards by LLG by Province

Open in 2013

Close in 2013

GAP Analysis

No. of LLGs

No. Open

No. Close

No. Open

No. Close

GAP Analysis

No. of Districts

No. Open

GAP Analysis

SOUTHERN REGION

1 Western 292 63 0 229 14 25 0 12 0 2 3 0 3

2 Gulf 150 25 11 125 10 10 0 9 0 1 2 0 2

3 Central 205 63 6 142 13 25 0 10 0 3 4 0 4

4 NCD - - - 0 0 - - - - - 3 0 3

5 MBP 394 56 30 338 16 30 0 8 0 8 4 1 3

6 Oro 162 58 4 66 9 12 0 5 0 4 2 0 2

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Sub-Total 1,203 265 51 900 62 102 0 44 0 18 18 1 17

HIGHLANDS REGION

7 SHP 476 99 12 123 20 32 0 7 0 13 5 1 4

8 Hela 256 74 3 182 12 24 0 4 0 8 3 1 2

9 Enga 365 80 42 164 15 24 3 6 0 9 5 2 3

10 WHP 304 82 1 222 9 20 1 4 0 5 4 1 6

11 Jiwaka 180 41 7 139 6 17 0 8 0 0 3 0 3

12 Simbu 317 56 3 361 20 23 1 8 0 12 6 1 5

13 EHP 264 87 6 177 24 25 0 5 0 19 8 2 6

Subtotal 2,162 519 74 1,368 106 165 5 42 0 66 34 8 29

MOMASE REGION

14 Morobe 559 206 35 276 33 19 0 15 0 18 9 1 8

15 Madang 441 199 6 211 19 26 0 18 0 1 6 1 5

16 ESP 647 260 5 387 26 30 0 9 0 17 6 1 5

17 Sandaun 346 154 11 192 17 25 1 9 0 8 4 1 3

Subtotal 1,993 819 57 1,066 95 100 1 51 0 44 25 4 21

ISLANDS REGION

18 Manus 127 46 9 81 12 0 0 10 0 2 1 1 0

19 NIP 138 57 0 81 9 20 0 7 0 2 2 1 1

20 ENB 386 59 3 327 18 19 0 10 0 8 4 1 3

21 WNB 111 46 18 65 11 18 0 8 0 3 2 1 1

22 ARB - 73 3 3 - 20 0 13 1 0 3 1 2

Subtotal 762 282 33 557 50 77 0 48 1 15 12 5 7

TOTAL 6,120 1,885 215 3,891 313 444 6 185 1 143 89 18 74

3.1.5 Accessibility to basic health care services facility

This must be the most pressing issue for any government or authority in a democracy

society like PNG. 80% of the people are directly affected. Provincial Governments,

Joint District Planning and Budget Priorities Committees and Local -Level

Governments cannot turn a blind eye to this alarming trend happening in their own

backyards and with the National Government only watching. The Department of

Health as the Lead Agency should be allowed to mobilize its Health Workforce and

resources and take pro-active action to change this scenario for the welfare of its

people. The evidence is here for all to see for themselves.

The Workforce and Facilities Gaps in the provision of basic primary health care

services to the majority of the population calls for urgent action by responsible

authorities in order to improve our health indicators.

To do this, the Health Manpower Development is considered a high priority under

the Arrest Plan. More trainee places and scholarships are made available and more

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resources be given to health training institutions including the Universities who

manage health related programs as a first step.

3.2: Gender & Age Distribution

There is no standardized mechanism or requirements set to deploy health care

workers across the country by their gender. The distribution is mainly on the

availability of position and driven by market value and whether it is at the National

or Provincial Health Administration. Giving less attention to gender and age

consideration of individual health worker could have significant implications in

terms of service delivery.

3.2.1 Gender Distribution

Table 3: Total Public Financed Service –Delivery Staff by Gender & Occupation

Category/ Function Male Female Total Male (%) Female (%)

Hospital/Urban

Medical Officers 246 82 328 75.0 5.0

HEOs 67 59 126 53.2 46.8

Nursing Officers 265 1,515 1,780 14.9 85.1

Midwives 12 80 92 13.0 87.0

CHWs 363 1,029 1,392 26.1 73.9

Dentist/D. Therapist 49 29 78 62.8 37.2

Total 1,002 2,794 3,796 26.4 37.2

Category/ Function Male Female Total Male (%) Female (%)

Rural Health Medical Officers 40 11 51 78.4 21.6

HEOs 185 100 285 64.9 35.1

Nursing Officers 468 1,004 1,472 31.8 68.2

Midwives 64 138 192 28.1 71.9

CHWs 1,620 1,386 3,006 53.9 46.1

Dentist/D. Therapist 31 11 42 73.8 26.2

Total 2,398 2,650 5,048 47.5 52.5 Source: World Bank Report – PNG Health Workforce Crisis “A Call to Action” October 2011

3.2.2 There are more male health workers serving in the rural areas then their

female counterparts. In the urban health facilities there are more female health

workers than their male counterparts. The Community Health Workers (CHWs),

Nursing Officers and Health Extension Officersgroups dominate in the rural health

facilities and while in urban health facilities, the Medical Officers and Nursing

Officers dominate in terms of numbers at these facilities (Urban Clinics and

Hospitals).

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3.2.3 Age Distribution

Figure 1: Analysis of the Current Health Service Delivery Staff at Rural Health

Facilities and Age Group

0% 20% 40% 60% 80% 100%

<24

25-34

35-44

45-54

55-64

65+

Total

1

22

115

101

40

5

285

13

256

476

518

202

7

1472

0

10

55

85

40

2

192

13

366

996

1207

341

83

3006

27

658

1661

1966

637

99

5048

Medical Officers

HEOs

Nursing Officers

Midwives

CHWs

Sub Total Rural Health

Key:

Age:

15

Figure 3: Analysis of the current health service delivery Staff and Age Group

0

200

400

600

800

1000

1200

1400

1600

1800

<24 25-34 35-44 45-54 55-64 65+ Total

Hospitals/ Urban

Medical Officers 0 40 148 108 27 5 328

HEOs 2 34 54 29 7 0 126

Nursing Officers 5 215 646 588 310 15 1780

Midwives 0 1 18 38 34 1 92

CHWs 0 100 479 585 216 12 1392

Dental/Dental Therapist 0 8 27 24 17 1 78

Wo

rkfo

rce

Nu

mb

er

Figure 2: Analysis of Current Health Service Delivery Staff at Hospitals /Urban Centers & Age Group

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Medical Officers

HEOs Nursing Officers

Midwives CHWs Dental Therapists

TOTAL

43 56 47111 466 9 1056

158 169 1122

731475

363033

139 130 1106

123

179248

3338

34 47 51274

557 24 12485 5 22 3 95 3 133

379 411 3252 284 4398 120 8844Total

65+

55-64

45-54

35-44

25-34

<24

Age:

Age

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3.2.4 The Figures 1-3 above shows the Age Groupings for both Primary Health Care

Workers in the rural areas and urban centres. Most of the health personnel fall with

-in the age group of 35 – 44 and 45 – 54 while a smaller number fall into the age

group of 25 – 34 and 55 – 64. There is no major difference between the Urban and

Rural Health Care Workers age grouping.

3.3:Roles of Rural Health Facilities &Urban Clinics

3.3.1 Each of the Rural Health Facilities and Urban Clinics has a different role in

providing health services. The AidPost, Community Health Post, Sub-Centre, Health

Centre and District Hospital serve the rural population while the Urban Clinics offer

clinical services to communities in towns and cities and the urban disadvantaged and

each level of facility are slightly different and depending on the categories of health

professionals placed at each facility.

3.3.2 The Aid Post, Sub-centre and the recent introduction of Community Health

Post are meant to serve very basic health care services. The Aid Post is staffed by

one Community Health Worker and Sub-Centrehas two CHWs and the recently

introduced Community Health Post will have one CHW, one Midwife, One Nursing

officer and probably one HEO and are expected to serve a population of

approximately 10, 000 people. The introduction of a Community Health Post is

meant to improve the maternal and child health at the rural areas. It is envisaged

that for the long term, the CHP will replace and phase out the Aid Post facility.

3.3.3 Urban Clinics perform the same role as the Health Centres. The Community

Health Workers, Nursing Officers and Health Extension officers manned the Urban

Clinics. The same composition of health workers are placed at the Health Centres.

Both the Urban Clinics and Health Centres provide similar clinical services to the

people. The size of the workforce at these two facilities did not specify in the

National Health Service Standards.

3.3.4 The District Hospital provides both curative and public health care services.

The composition of the workforce include CHWs, Nursing Officers, HEOs, General

Medical Officers and some professional Allied Staff depending on the kind of support

health services each District or Rural Hospital provide. Further, Administration

Officers are non-excludable in all health care facilities to provide management and

administration.

3.3.5 Community Health Workers are trained to serve in the rural health facilities

from Aid Post to the District Hospital. The CHWs Curriculum and training is designed

to focus on public health while the Health Extension officer training is more to do

with clinical and management of the rural health facilities. The Nursing Officers

and General Medical Officers training is very much clinical management of the cases

and moreconcentrated with curative health then public health as per the current

staffing information.

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3.4:Private Sector Rural & Urban Clinics Health Care Service Workforce

Churches and other Private Health Care Facilities

3.4.1 The Churches have been a major partner to the Department of Health in Papua

New Guinea from the beginning. The Christian Health Services provide 50% of the

health care services mostly in the rural areas and provide education and training of

health professionals, in particular, the Nursing and Community Health Workers for

many years. Recently, Divine Word University took over the College of Allied Health

Science and now trains Health Extension Officers, Environmental Health Officers and

Health Administration Officers.

3.4.2 The Church Health Services operate 342 health care facilities and the listing

below is a summary of the different levels of health facilities;

1. There are 14 Urban Clinics but urban hospital

2. There are 43 Health Centres

3. There are 278 Health Sub centres

4. There are 6 Rural Hospitals and 1 District Hospital

N/B More information on Christian Health Services are discussed in Section 4 of this

document

3.4.3 Most of the Churches facilities are located throughout the country and are

predominantly rural base facilities delivering health care services and supporting the

Department of Health and Provincial and Local –Level Government in their outreach

program. Under the National Constitutional, it is the responsibility of the

Government and its Department of Health to provide basic health care services to

the people but churches are playing a major role in the actual delivery of health

services.

3.4.4 There are a good number of other health service providers who use their own

resources to offer such services. Among them are the Mining & Petroleum

Companies, other International Corporations, Faith Base Organizations and NGO

Groups including Private Medical Practitioners‟ who provide health care services in a

form of business. There are number of health care facilities under this category and

the facilities we have estimated are the following;

14 Urban Clinics but no Hospital

6 Health Centers

7 Health Sub-Centers

2 Rural Hospitals

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Private Sector Health Workforce

3.4.5 There are 3,562 health workers serving in private health facilities while the

public health system has a total manpower of some 8,732 health workers. The total

health workforce in the national health services system is estimated to be about

12,294 altogether.

Table 4: Indicates the number of health personnel serving in private health facilities

in the country by Province.

Western 176 SHP 364 Madang 86 Gulf 117 Enga 319 ESP 308 Central 97 WHP 403 WSP 220 NCD 171 Simbu 92 Manus 38 MBP 259 EHP 198 NIP 229 Oro 45 Morobe 83 ENB 212 WNB 131 Bougainville 14

Source: World Bank Report –PNG Health Workforce Crisis “A Call to Action” October 2011

3.5: Staff Constraints 3.5.1:Low Supply of Skilled Labour from Training Institutions 3.5.1.1 Previous decisions of past Governments on the PNG Structural Adjustment Program (SAP) in 1998 led to closing down four (4) Government Nursing Schools in order to make savings to the national purse and this decision is having a direct impact in the training number of trained Health Workers today. The World Bank Report that reviewed the Health Workforce Capacity in 2009; had rung the alarm bell for urgent action to be taken immediately. The WBR titled “PNG Health Workforce Crisis – A Call to Action” provide substantive evidence for the government to act immediately. 3.5.1.2 The current remaining Schools and Colleges of Nursing and CHW Schools and University of Papua New Guinea (UPNG) and other Universities such as the DWU, PAU and UOGcannot train sufficient health workers to meet the needs of the growing population in PNG. ALL were approved to increase their enrolment intake to train more nurses. 3.5.1.3 Current resource allocations and funding levels provided to the existing health training institutions are inadequate to expand their capacity to produce the required number of health workers. The government at the moment is relying heavily on good will and faith ofChristian Health Services to increase their enrolment and train new health workers through their respective training schools. They will need additional funding from the government to pay for staff salaries, operational costs and additional infrastructure development. The Christian Health Services have five (5) Nursing Schools, twelve (12) CHW Training Schools and

19

recently the Divine Word University took over the running of the College of Allied Health Science (Madang) and the continuously training the Health Extension officers, Environmental Health officers and Health Administration officers. 3.5.1.4 The Health sector workforce had got into its present situation for the following reasons: No large increases in student enrolment of health training schools and institutions; an aging workforce population; staff getting their retirement and or redundancies benefits as it matures; on disciplinary cases, othersthrough natural causes and above all those that leave the health service for greener pastures elsewhere (into the private sector or overseas). All these human resource issues and challenges are creating a huge gap in the national health workforce today and demand government intervention almost immediately. 3.5.2: Unequal Skill Mix and Disparity in the distribution of Health Care Workers 3.5.2.1 Since Independence in 1975, PNG health sector has continue to experience disparity in the distribution of health care workers. There are no guidelines or benchmark that sets the distribution of different cadres of health workers to each level of health service facilities in the 89 Districts and 22 Provinces in the country. 3.5.2.2 The distribution of health care workers is primarily on the availability of positions at each level of the health facility and also depends entirely on the position market, whether it is at the National or Provincial Health Administration. The Organic Law on Provincial & Local Level Governments demarcates the roles and responsibility of the Provincial Health Administration from the National Health Administration. Recruitment and placement of health care workers to provinces are the responsibility of the provincial administration. The National Department of Health determine the professional standards and should ensure appointing authorities use in the considering suitable applicants and or placement in all health facilities. 3.5.2.3 Unless the National Department of Health work very closely with all provincial administrations regarding these human resource issues, it will continue to experience disparity in the distribution of the workforce resulting in unequal skill mix at the facility level.It is imperative that the Department now address this issue of disparity in the workforce and have mechanisms in place to determine the distribution of health workers to have proper skill mix at each facility level. Further, deployment of Health workers based on population density and service demands per districts in the provinces to improve the health indicators in PNG. 3.5.3: National Health Service Standards & Manpower Ceiling Set by DPM 3.5.3.1 The Health Service Minimum Standards which is now called the National Health Service Standards need to specifically spell out the manpower ceiling requirements for each facility based on service demands and identify all positions of the different cadre of health workers for these health facilities and including the organizational structure of these facilities to Department of Personal Management (DPM) for approval and for budgetary consideration.

20

3.6: Summary of Total Health Workforce Manpower

3.6.1 The focus of the Arrest Plan is on the frontline health workforce delivering

primary health care. Table 5 and accompanying Graphs 1-3below provides a

comparison of workforce at the rural health facilities and urban health facilities

across the country. Table 5 gives a summary on health manpower but this does not

necessarily represent the actual situation.

Table 5: Total Public Sector Funded Employees (Urban and Rural) 2009

Staff Category Urban Rural Total % Urban % Rural

1 SERVICE DELIVERY STAFF

Medical Officers 332 51 383 86.7 13.3

HEOs 175 285 460 38.0 62.0

Nursing Officers 1,807 1,472 3,279 55.1 44.9

Midwives 101 192 293 34.5 65.5

CHWs 1,412 3,006 4,418 32.0 68.0

Dentist/Dental Therapist 79 42 121 65.3 34.7

Subtotal Service Delivery Staff 3,906 5,048 8,954 43.6 56.4

2 SERVICE DELIVERY SUPPORT STAFF

Medical Lab Assistant/ Tech 117 65 182 64.3 35.7

X-Ray Technicians 53 7 60 88.3 11.7

Pharmacist 71 21 92 77.2 22.8

Environmental Health Officers 69 74 143 48.3 51.7

Training Coordinators 33 10 43 76.7 23.3

Subtotal Service Delivery Support Staff 343 177 520 66.0 34.0

3 ADMINISTRATION STAFF Administration Support Staff 696 182 878 79.3 20.7

Other Support Staff 419 260 679 61.7 38.3

Cleaners 129 180 309 41.7 58.3

Drivers 121 216 337 35.9 64.1

Casuals 732 199 931 78.6 21.4

Subtotal Administration Staff 2,097 1,037 3,134 66.9 33.1

4 Nat. Dept. Of Health HQ

Medical Officers 62 0 62 100.0 0.0

HEOs 26 0 26 100.0 0.0

Nursing Officers 41 0 41 100.0 0.0

Midwifes 5 0 5 100.0 0.0

CHWs 1 0 1 100.0 0.0

Dental Therapist 4 0 4 100.0 0.0

Subtotal NDOH Service Delivery Staff 139 0 139 100.0 0.0

5 NDOH HQ Support Service Staff

Med. Lab Assistant & Tech 13 0 13 100.0 0.0

X-Ray Technicians 3 0 3 100.0 0.0

Pharmacist 16 0 16 100.0 0.0

Health Environmental Officers 24 0 24 100.0 0.0

Subtotal NDoH Service Delivery Staff 56 0 56 100.0 0.0

21

6 NDOH HQ Administration Staff Administration Staff 210 0 210 100.0 0.0

Other Support Staff 50 0 50 100.0 0.0

Subtotal NDoH Administration Staff 260 0 260 100.0 0.0

Total NDOH Staff 455 0 445 100.0 0.0

TOTAL HEALTH STAFF 6,801 6,262 13,063 52.1 47.9

Source: World Bank Report" PNG Health Workforce Crisis -A Call to Action" October 2011

3.6.3 Total Manpower Summary for Hospitals and GAP Analysis

3.6.3.1 Table 6 shows the total manpower summary and the existing Gaps in the

Provincial Hospitals for each region. For detail information on the staff strength,

vacancies and staffing demand based on service requirements see the information

and data below.Those Provincial Hospitals that did not provide information on their

current workforce gaps are indicated as nil information.

Table 6: Total National Hospital Manpower Summary by Facility by Region

No: Provincial Hospitals Total Staff Ceiling

Staff on Strength

Staff Projected Current Age Category Notes

(Funded

Positions)

GAPS/or

Vacancies

Based on Service Demand 21-30 31-40 41-60

New Guinea Islands

1 Nonga Base Hospital 418 308 110 418 56 98 154

2 Kimbe Hospital 255 172 83 130 26 101 102

3 Lorengau Hospital 108 106 7 9 9 12 32

4 Buka Hospital 300 148 152 300 0 12 165

5 Kavieng Hospital 173 140 25 960 8 24 80

Sub Total 1,254 874 377 1817 99 247 533

Momase Region

1 Angau Hospital 726 451 275 60 77 117 95

2 Modilon Hospital 534 325 209 73 0 6 19

3 Boram Hospital 235 155 168 41 37 3 4

4 Sandaun Hospital 276 159 16 132 63 53 43

Sub Total

1,771 1,090 668 306 177 179 161

Highlands Region

1 Wabag Hospital 334 256 69 486 37 51 108

2 Mendi Hospital 372 306 101 69 0 10 1

3 Mt. Hagen Hospital 830 799 30 1000+

4 Kundiawa Hospital No Information Received

5 Goroka Hospital No Information Received

Sub Total 1,536 1,361 200 1,555+ 37 61 109

Southern Region

1 Milne Bay Hospital 276 181 94 134 33 126 98

2 Kerema Hospital No Information Received

3 Popondetta Hospital No Information Received

4 Daru Hospital No Information Received Sub

Total 276 181 94 134 33 126 98

22

Specialist Hospitals

1 Laloki Psychiatric Hospital 160 210 113 128 6 51 48

2 Port Moresby Referral Hospital 1,347 907 731 0 109 238 293

Sub Total 1,507 1,117 844 128 115 289 341

Total 6,344 4,623 2,183 3,940 461 902 1,242

SECTION 4: CURRENT CHRISTIAN HEALTH SERVICES

4.1: Introduction

4.1.1 This section was written by the Christian Health Services and presented to

support the Arrest Plan recommendations on the health workforce. It provides an

update status on Church Health Staffing and Facilities in the countrywho are an

important partner with the government in actual delivery of services in the country.

4.2 Background

4.2.1 “Christian Health Services [CHS] was formed in 1965. It is an organization

whose membership consists of Churches and Faith Based Christian Organizations who

are involved in delivering of Health work in Papua New Guinea. It has a total

membership of 27 - of which 23 are Churches and 4 are Christian Organizations.

Christian Health Services is by far the largest NGO group partnering the Provincial

and National Governments in providing Health Services, especially in the rural areas

of PNG where the bulk of the population lives.

4.2.2 Christian Health Services have a total of 695 operating facilities, 324 Aid Posts,

360 HCs and 11 Rural Hospitals. From the 695 operating facilities a total of 184 are

unfunded of which,164 are Aid post and 20 Health Centres.

4.2.3 The total staff on strength is 3,476 and 2,915 positions are funded while 561

positions remain unfunded.

4.2.4 The National Government through NEC decisions under the Public Grants

Allocations, funds the salary and operational components of CHS, however, not all

positions in the 564 facilities are funded. This is something CHS has made several

attempts through the yearly budget process to achieve since 2010.

4.2.5 The Christian Health Services also has a total of 17 Training Institutions that

are run by various Member Churches. Five [5] of these are Schools of Nursing [70%]

and 12 are Community Health Worker Training Schools which turns out to be 100%

operated by CHS.

4.2.6 CHS encourages all its members to develop the highest level of Health Care

that promotes physical, social, psychological and spiritual development for the

people of Papua New Guinea within the framework of the National and Provincial

23

Government Health Policies, and in so doing offering them the belief in Christ as the

Healer of all men.

4.2.7 CHS also encourages its members for co-operation between member

Organizations, the Provincial and National Governments in matters of common

concern and interest in health. It also gives special consideration to the best

possible ways of providing Community Health Services, Training Programs, Joint

Planning and sharing of resources.

4.2.8 CHS strongly emphasizes that all Church Health Secretaries do monthly

Financial and Clinical Reports at the facility levels and summary of the reports

should be sent to the Provincial Health Advisor‟s Office. A copy of that summary is

also sent to the National CHS Secretariat Office where they are analysed to produce

quarterly reports and distributed to NDOH, Finance, Treasury and National Planning

and Monitoring.

4.3: Vision

4.3.1 Christian Health Services as a constitutional organization will strive to carry

out the healing ministry of Jesus Christ by providing quality and affordable health

care for all the people.

4.4: Mission

4.4.1 Inspired by the gospel of Jesus Christ we strive to provide the best health care

with dignity, respect, compassion and dedication in partnership with the

government and non-government health providers through health promotion,

training, clinical care and evidence based research work.

4.5: The Christian Health Care System

4.5.1 The CHS has no separate health policy directives by which it governs and

determines its operations. It partners with the National Health Department in

implementing the department‟s policy directives and any national health plan that is

available from time to time.

4.5.2 In so doing CHS are an integral part of the overall health plan both at the

national and provincial level. Not only in the planning stage, but also in the

implementation, monitoring, and evaluation processes.

4.5.3 The functions of the CHS is administered and guided by the National

Secretariat Office with some of its powers are delegated back to the provinces with

respective provinces must have a provincial CHS whereby matters of mutual

concerns are shared for the benefit of all CHS operating in that province.

4.5.4 There is an annual assembly where all members of the CHS are obliged to

attend to hear reports of their previous year‟s performances apart from other

24

business matters. It is at this level that resolutions are passed for how CHS wish to

see business of health service delivery is addressed.The fact that National

Secretariat Office coordinates and monitors the performances of its members, a lot

of administrative powers rests with the respective agencies.

Figure4: CHS Organisational Structure

4.6 Christian Health Services in Papua New Guinea

4.6.1 Table 7: Summary of Staffing and Facilities in the Country

Table 7: CHS Agencies by Agency, by Province &by Region

SOUTHERN REGION

NO: Province Agency Presence in

Province No. of

Facilities No. of Staff

WESTERN 50% 59 CEILING ON STRENGHT

1 CATHOLIC

50 84

2 ECPNG N/F

50 60

3 ECPNG M/F

89 84

25

GULF 50% 45

4 CATHOLIC

48 74

5 GULF CHRISTIAN H/SERV

57 23

6 SALVATION ARMY

0 2

7 UNITED

50 51

CENTRAL 46% 39

8 CATHOLIC

71 88

9 NAZARENE

0 4

10 PNG BIBLE CHURCH

2

11 SEVENTH DAY ADVENTIST

11 11

12 SALVATION ARMY

19 16

13 UNITED

22 20

MILNE BAY 61% 7

14 ANGLICAN

46 43

15 CATHOLIC

57 94

16 UNITED

77 111

ORO 26% 39

17 ANGLICAN

41 45

18 EBC

4

19 SALVATION ARMY

3

NATIONAL CAPITAL DISTRICT TBA 9

20 CATHOLIC

2 32

21 FOUR SQUARE

4 29

22 HOPE WORLD WIDE

11 18

23 SALVATION ARMY

5

24 SEVENTH DAY ADVENTIST

7

25 NATIONAL SECRETARIAT OFFICE

5 7

HIGHLANDS REGION

NO: Province Agency

% CHS Presence in

Province No. of

Facilities No.ofStaff

HELA Ref to SHP Ref to SHP CEILING ON STRENGHT

26 CATHOLIC

8 10

27 CHRISTIAN BRETHERAN CHURCH

13 21

28 EVANGELICAL CHURCH OF PNG

15 34

29 GUT NUIS LUTHERAN

60 4

30 HELA GUTNUIS

6

31 UNITED

10 37

32 WESLEYAN

9 7

SHP 60% 98

33 CATHOLIC

42 51

34 CHRISTIAN UNION MISSION

16 23

35 EVANGELICAL CHURCH OF PNG

28

36 GUT NUIS LUTHERAN

3 5

37 PNG BIBLE CHURCH

16 16

38 UNITED

48 13

39 WESLEYAN

4

ENGA 29% 31

40 BAPTIST UNION

47 55

26

41 CATHOLIC

54 57

42 FOUR SQUARE

0 2

43 GUT NUIS LUTHERAN

60 64

WHP 49% 55

44 BAPTIST UNION

62 37

45 CATHOLIC

41 46

46 CHRISTIAN APOSTOLIC FELLOWSHIP

1

47 EVANGELICAL LUTHERAN

33 41

48 PNG BIBLE CHURCH

10 6

49 SEVENTH DAY ADVENTIST

10 12

JIWAKA Ref to WHP Ref to WHP

50 ANGLICAN

17 20

51 CATHOLIC

34

52 CHRISTIAN APOSTOLIC FELLOWSHIP

4

53 CLTC

4 3

54 EVANGELICAL BROTHERHOOD CHURCH

20 22

55 NAZARENE

104 103

56 SDA

3

SIMBU 26% 21

57 ANGLICAN

5 7

58 CATHOLIC

66 84

59 CHRISTIAN OUTREACH CENTRE

4

60 EVANGELICAL LUTHERAN

10

61 HOPE WORLD WIDE

1

62 SALVATION ARMY

6 1

63 SDA

4

EASTERN

HIGHLANDS 38% 68

64 CATHOLIC

7 7

65 EVANGELICAL BROTHERHOOD CHURCH

55 59

66 FAITH MISSION

8 9

67 FOUR SQUARE

9 13

68 INDEPENDENT BAPTIST

4 7

69 EVANGELICAL LUTHERAN

3 4

70 OPEN BIBLE

8 8

71 SALVATION ARMY

26 29

72 SEVENTH DAY ADVENTIST

4 11

73 SUMMER INSTITUTE OF LINGUISTICS

5 11

74 TRINITY BAPTIST

Facility not Operating

MOMASE REGION

NO: PROVINCE AGENCY

% CHS Presence in

Province No of

Facilities No. of Staff

MOROBE 26% 47 CEILING ON STRENGHT

75 CATHOLIC

12

76 EBC

3 5

77 EVANGELICAL LUTHERAN

187 224

78 NAZARENE

3 2

MADANG 38% 57

27

79 CATHOLIC

67 80

80 EBC

7 13

81 EVANGELICAL LUTHERAN

108 133

82 NAZARENE 6 3

EAST SEPIK 67% 40

83 CATHOLIC

97 126

84 ECOM

4 6

85 EVANGELICAL LUTHERAN

4 4

86 NAZARENE

87 SDA

14 18

88 SSEC

32 56

SANDAUN 71% 30

89 BAPTIST UNION

41 29

90 CATHOLIC

119 137

91 CHRISTIAN BRETHERAN CHURCH

24 27

NEW GUINEA ISLAND REGION

NO: Province Agency

% CHS Presence in

Province No. of

Facilities No. of Staff

MANUS 25% 3 CEILING ON STRENGHT

92 CATHOLIC

12 12

93 EVANGELICAL CHURCH OF MANUS

6 15

NEW IRELAND 33% 11

94 CATHOLIC

75 70

95 UNITED

37 35

EAST NEW BRITAIN 42% 17

96 CATHOLIC

186 190

97 UNITED

9 20

WEST NEW BRITAIN 59% 25

98 ANGLICAN

9 14

99 CATHOLIC

129 116

100 LUTHERAN

2

101 UNITED

7 9

NORTH SOLOMONS 39% 24

102 CATHOLIC

84 116

103 UNITED

46 45

28

4.7: Funded Health Facilities by the Government

Table 8: Summary of CHS Provincial Facilitiesin the Country.

Table 8 : CHS Provincial Facility Totals

Province Funded

HC's

Funded HC's (Removed from List)

Funded AP's

Funded AP's

(Removed from List)

Unfunded AP'S

Unfunded AP's

Total Facilities

in Provinces

Western 21 1 11 7 - 19 59

Gulf 12 - 18 4 - 11 45

Central 17 - 11 5 1 5 39

National Capital District

6 - - - 1 - 7

Milne Bay 25 - 12 1 - 1 39

Northern 5 - 3 - - 1 9

Southern Highlands 39 1 20 3 3 32 98

Enga 15 2 - - - 14 31

Western Highlands 32 2 4 3 5 9 55

Simbu 9 1 3 1 2 5 21

Eastern Highlands 16 - 26 - - 26 68

Morobe 15 3 21 1 1 6 47

Madang 21 - 21 4 1 10 57

East Sepik 27 - 4 1 1 7 40

Sandaun 26 - 1 - 2 1 30

Manus 3 - - - - - 3

New Ireland 11 - - - - - 11

East New Britain 13 - - - - 4 17

West New Britain 13 - 5 - - 7 25

North Solomons 14 1 - - 3 6 24

Sub Totals 340 11 160 30 20 164 684

Total 351 190 20 164 725

4.8: Training Programs

4.8.1 The training institutions, namely General Nurses and Community Health

Worker schools implement the curriculum set by the NDOH through its Pre and In-

Service Training division under Human Resource Management Branch

4.8.2 CHS has benefited from various in-service programs conducted at provincial

level as well as national level. However there needs to be more coordination in post

29

graduate training programs offered in country as well abroad so that resources can

be utilized for maximum benefit by all health service providers.

4.8.3: Other Training Programs

4.8.3.1 There have been other health training programs been conducted and proven

to be working effectively in the respective places.

4.8.4 Village Health Volunteer

4.8.4.1 Different CHS Agencies use different names for the same concept but have

trained a good number of VHV who providing small but very vital health care for

their catchment population. These people are trained not only to treat minor

ailments but act as role models for changed behaviour and attitude so people in

their villages learn to adapt to such holistic health approach.

4.8.5.Rural Masters in Medicine

4.8.5.1 This Program has been running for 5years and will soon see its first graduate

in masters in rural medicine this year. It is trying to offer our doctors a different

working environment. The graduates will certainly need to occupy a position and

those positions needs to be made available.

4.9: The Schools Current Facility

4.9.1 At the moment there are constraints including land availability on which to

teach and supervise the students and this will couple with increased intakes. Besides

the schools needs to have support staff to effectively support the schools

administration.

Table 9:Summary ofTraining Manpower

Table 9. CHURCH TRAINING SCHOOLS- STAFFING

SOUTHERN REGION

NO: PROVINCE SCHOOL

TYPE OF

SCHOOL STAFF

WESTERN

CEILING ON STRENGHT VACANT

1 RUMGINAE CHW 6 6 0

GULF

2 KAPUNA CHW 6 5 1

CENTRAL

3 ST GERALD'S VEIFA'A CHW 6 6 0

4

PACIFIC ADVENTIST

UNIVERSITY GN 16 11 5

30

MILNE BAY

5 SALAMO CHW 6 4 2

6 ST BARNABAS GN 12 7 5

ORO

7

ST MARGARET'S CHW 6 4 2

HIGHLANDS REGION

NO: PROVINCE SCHOOL

TYPE OF

SCHOOL STAFF

SHP CEILING ON STRENGHT VACANT

8 KUMIN (DET) CHW 6 3 3

WHP

9 TINSLEY CHW 6 6 0

10 NAZARENE GN 12 12 0

EASTERN HIGHLANDS

11 ONAMUGA CHW 6 4 2

MOMASE REGION

MOROBE

12 BRAUN CHW 6 6 0

MADANG

13 GAUBIN CHW 6 4 2

14 LUTHERAN GN 16 14 2

SANDAUN

15 RAIHU CHW 6 5 1

NEW GUINEA ISLAND REGION

NEW IRELAND

16 LEMAKOT CHW 6 6 0

EAST NEW BRITAIN

17 ST MARY'S VUNAPOPE GN 12 11 1

4.10: Human Resource Management

4.10.1 Understanding the capacity building status and managing human resource is

of paramount importance in designing the „Arrest Plan‟. While respective CHS

Agencies derive their own policies for human resource development, it is also

31

imperative that CHS National office must develop systems to enhance the

development of its workforce. These could be handled in a number of ways through

donor partner assistance, through scholarships, Church Agencies Sources, internal

arrangements etc.

4.10.2 On the other hand, positions must be created and made available so that

graduates are offered a placing in the church and government system. Why do we

have to have so many graduates without formal public service positions as they are

professionals and kept and paid as casuals? It is a frustration experience for the

young doctors and nurses to find themselves in this situation.

4.10.3 The National Health Service standards should be used as the minimum guide

to enable employers to employ health professionals without having the fear of a

casual /temporary employment.

4.11: Graduates into the National Health System

4.11.1 The graduates coming out from the CHS training institutions are employed by

any health care provider in PNG. While a small number is retained by CHS, the

majority are employed by the government and in recent times by Mining Companies.

4.11.2 The graduates in many cases use the CHS as a stepping stone into entering

government funded hospitals due the better conditions and career paths.It has been

ascertainedthat movements of graduates from rural institutions to urban

employment has had major staff impacts on the quality of services delivery inrural

communities.

4.12: Summary

Many reforms have transpired over the years but with mixed results.However, this

health workforce plan is hope to succeed for the Health Department as it is directly

involved in determine the way forward for its workforce development. CHS is an

important partner committed to fully participate and be given the opportunity to do

so. CHS is a committed partner working with National Department of Health in

ensuring its key priority areas in health service delivery are addressed.

Section 5: Training Responsibility

5.1 Introduction and Background to Training.

5.1.1 The training of the health workforce was introduced into country by the Missionaries as documented by Christian Health Services. They conducted training programs that included: Aid Post Orderly, Nurse Aide, Nurse Training and entry to the Programs were from grade 6 later 8 school leavers. They conducted these programs to deliver the very basic health care at the Community level. These programs were later delivered by both Government and Church Health Agencies through the many schools ranging from small to medium large Training Schools in the country.

32

5.1.2 In the early 1960S the first PNG Medical students (Medical Officers) were educated and trained Fiji and then employed by the Department of Health. Later, the Medical officers and Allied Health training was established under Para Medical College Port Moresby, Taurama Campus to cater for the country‟s needs.The programs conducted by the College then included the Pre Service Teacher Education and the Health Educators apart from the Medical Officers, Allied Health Science and Basic NurseTraining. 5.1.3 The Para Medical College in Madang produced the Health Extension Officers as there were not enough Doctors trained for the country. Health Inspectors Program was another now called the Environmental Health Programs. The two Para Med Colleges became known as the College of Allied Health Sciences and were under the National Department of Health until implementation of Higher Education Reforms in the mid-1980s and onwards. 5.1.4 Since the country gained Independence in 1975, followed by the Provincial Government system in 1976/77 and 1995 Provincial Governments and LLG Reforms, the Health Training programs remained under the responsibility of the National Government while the delivery of the health services came under the Provincial Administration and the Rural Hospitals. The decisions ON the Structural Adjustment Programs (SAP), to reduce Public Service Machinery to save costs resulted in closure of some training institutions in Nursing, Nurse Aid and the Aid Post Orderly training Schools. The other Nursing Schools, Arawa and Rabaul closed operations due to human and natural disasters that occurred in the 1990s. 5.1.5 The remaining training institutions could not cope with the increases in School -Leavers Applicants and as a result of the closedschools in the country. This is evident today with the overcrowded clinics and Hospitals and Aid Posts which are closed due to lack of staffing seen throughout the country. In addition, the fact that the population is increasing and graduate output coming out from these Schools and Colleges is inadequate; this has created the current problems with insufficient staff numbers.Table 12 summarises the health coverage due to closure of Aid Posts and ward coverage not being reached. 5.1.6 The Taurama Campus now known as the School of Medicine and Health Sciences (SOMHS) under University of Papua New Guinea (UPNG) is responsible for Doctors and Allied Health Science training including Public Health and Nurse Clinical and Managerial training. 5.2 Training Responsibility 5.2.1 The responsibility for the Training Development is a National Department of Health function historically until in the 1990s when the responsibility became a shared one with the Office of Higher Education. These Institutions; Nursing, Allied Health and Para Medical Training Institutions were known as the Higher Learning Institutions with the Universities except for the CHW Training thus this Health Training came under the National School Scholarship System.

33

5.2.2 The Training Responsibility is still a National function of government with the Pre service/Undergraduate, staff development and continuing professional development training programs including the policy related in service training. The Schools and Colleges of Nursing Programs are not fullyattached to Universities as yet. Section 5.2.3 Office of Higher Education (OHE)

5.2.3.1 In the 1990s the structure of the post-secondary education system evolved in many ways where the health related training institutions under Higher Learning Institutions have upgraded their entry into programs including increasing the duration of the program. The Taurama Campus now responsible for the Medical doctors and Allied Health Science officers training and entry to these programs has gone from post grade 10 Science foundation to grade 12 and the duration for the doctors and Allied Health Science is five years. 5.2.3.2 Divine Word is a NGO University which produce the Allied Health Workers such as the „Rural Health Extension Officers‟ and other Allied Health and Health Support Programs. Both Universities although come under Higher Education System as Universities, each has their own Legislation to manage their own affairs and the National Department of Health is only a partner. 5.2.3.3 Currently, the programs that come under the dual responsibility role of OHE and NDoH are the Nursing Schools and Colleges whereby OHE is responsible for the Scholarship System components while NDoH is responsible for the operational aspect of theseinstitutions. The OHE implements the scholarship system for the development of „Human Resources in the country as part of its function in the „integral human development principle in the national constitution. These institutions have implemented Higher Education Reforms and done further rationalisation and some have merged fully with universities to ensure there is quality of education achieved through their education standards and programs qualify under the „Qualification framework‟. 5.2.3.4 There is closer collaboration by National Department of health with the Office of Higher Education in the recruitment of the school leavers in undertaking training at the Health Training Institutions. 5.2.4 Role of NDoH 5.2.4.1 The Department of Health is the biggest employment agency of the graduates output from the health training institutions, and continue to be recognized by the GoPNG as the primary agency responsible for the Health Training Institutions which is a national function. It participates by providing the projected numbers it requires through the Office of Higher Education which are used as the basis for students‟ recruitment into the training programs. 5.2.4.2 The Role of the NDoH for the CHW is of resource mobilisation so that the programs are delivered successfully by the Christian Health Services training schools. For the Nursing Schools and Colleges that have not amalgamated to the Universities, the National Department provides the annual staffing and operational funding to

34

these schools. There are three (3) Government Schools and Colleges of Nursing and the five – run Church Nursing Schools and Colleges. The NDoH also administer the „Residential Programs‟ whereby the graduates of; (1) MBBS (Bachelors in Medicine and Surgery), RHEOs, and other Allied Health during their two year Residency program, a pre-registration program that qualifies them to gain their full licence as safe professional health workforce to the community. Thus annually the National Department budgets for the pre service programs which covers; the CHW, Nursing, Residency programs and further for the continuing and the staff development programs. 5.2.4.3 The continuous training for the workforce supply is based on budget and training infrastructure capacity in terms of space and staffing on ground. Another hurdle experienced upon completion of the program is the waiting time for the registration of the graduates in particular nursing and CHW astheir absorption into the workforce is dependent on having a licence to practice. We need more trainee positions to minimise these obstacles. The Public Service arrangement does not work in this context and changes are needed.

5.2.5 Role of Training Schools 5.2.5.1The Managers of the Training Institutions are qualified health workers who

hail from the Health Training Programs and they are; Deans, Principals of the Schools and Colleges or Deans within the Programs that come under the Universities.

5.2.5.2 They ensure first and foremost that the Programs delivered by their

Respective Institutionis: 1. Programs approved and accredited by the Professional Regulatory Board

whether this be Medical or Pharmacy Board or Nursing Council. 2. There is adequate resource in way of finance, facilities, teaching and

learning and qualified staff of appropriate skill mix in place to deliver the programs. These Program delivered is accredited by the Professional group as well the University Academic Senate to ensure requirements are met (educational standards).

3. The Program delivered has Quality Management Systems in place to monitor and evaluate the process of the delivery of the program, and

4. Finally there are supporting systems proximal for the success of the programs such as the practicum sites where the Health Facilities utilised are accredited and meet the training requirements.

5.2.5.3 NDoH to involve the Principals of the Schools and Colleges of Nursing and the Community Health Worker Schools to participate in the manpower review and budget for the operational needs of the training institutions.

5.2.6 Role of the Provincial Government. 5.2.6.1 Provincial and LLGs are the extension of the government administrative systems in provinces under the Organic Law on Provincial Governments and Local Level Governments in the country. They each have functional responsibility for

35

electorates under their jurisdictions and are important players of health administration for their communities. Communication linkagesbetween and among agencies is very important for resource allocation, training, facility development and community support to the Health Workers in the delivery of health services. 5.2.7Role of the Development Partners 5.2.7.1 The Development Partners such as the World Health Organisation (WHO) and the United Nations Agencies (UN), Australia and New Zealand /Japan Governments including countries as well have assisted financially and provided technical expertise in the health service delivery. They have assisted in training by providing scholarship to an increasing numbers of midwives and paediatric nurses for further education and skills development.

5.2.7.2 Each year through this Development Partnership, the GoPNG is being assisted to deliver the health programs and in other cases some are working in parallel to deliver the services.

5.2.7.3 Development Partner Program should offer more Scholarships places for health workforce for professional development.

5.2.8 Role of Churches

5.2.8.1 The Role of Churches has been discussed extensive In the Arrest Plan because the Christian Health Services play a very important role in the delivery of health services in the country. At present they provide 100% of the CHW health workforce training through their 12 Schools and about 50% of Generalist Nurse Training in the Country.

Section 6: Training Providers, Programs and Training Issues

6.1 The Training of health workers comes under six providers under a number of programs: -Pre Service and the Undergraduate Programs, the Continuing and Staff Development Programs and the In Service Training Programs. The Tables; 10, 11 and 12 below show the relevant training providers of these programs. Table 10: Providers of the Pre Service /Under Graduate Programs Programs Entry

Level Duration Level of

Program Providers of the Programs No of

Schools

Community Health Worker

10 2 years Certificate Churches (see Table 11 for listing of Church Agencies) & 12 Provinces located in.

12

Nursing 12 3 years DGN Churches & Government located in 8 Provinces see listing Table 12.

7

Bachelor Nursing 12 4 Degree SOHS - Pacific Adventist University 1

Physiotherapist 12 4 Degree DWU 1

Bachelor Rural Health (HEO)

12 4 Degree Divine Word University 1

EHO 12 4 Degree Divine Word University 1

Bachelor Health Management (BHM)

12 4 Degree DWU 1

Bachelor Oral Health 12 4 Degree UPNG, SOMHS 1

36

(BOH) Taurama Campus

Bachelor Dentistry Surgery (BDS)

12 4 Degree UPNG, SOMHS Taurama Campus

1

Bachelor Pharmacy 12 4 Degree UPNG, SOMHS Taurama Campus

1

Bachelor Medical Laboratory Sciences

12 4 Degree UPNG, SOMHS Taurama Campus

1

Bachelor for Medical Imaging

12 4 Degree UPNG,SOMHS Taurama Campus

1

MBBS 12 5 Degree UPNG, SOMHS Taurama Campus

1

Source: Training Data

6.2 The twelve (12) CHWs Schools operated by the Christian Health Agencies offer a two year Certificate Course as per the Table 11 and their location in the Provinces.

Table 11: CHW Schools in PNG

Name of School Location Church Agency Province

Braun Braun/Finchhafen Lutheran Morobe

Gaubim Karkar Island Lutheran Madang

Lemakot Lemakot/Kavieng Catholic New Ireland

Kapuna Baimuru/Kapuna Gulf Christian Health Services (CHS)

Gulf

Kumin Mendi (Det) Catholic Southern Highlands

Onamuga Onamuga/Kainantu Salvation Army (SA) Eastern Highlands

Raihu Aitape Catholic Sandaun

Rumginae Rumginae/Kiunga Evangelical Church of Papua (ECP)

Western

St. Gerard Veifa,a Veifa‟a/Bereina Catholic Central

St. Margaret Popondetta Anglican Oro

Salamo Ferguesson Island United Church (UC) Milne Bay

Tinsley Bayer River Baptist Western Highlands

Source; Training Data

Table 12: Schools of Nursing by location, Agency/Province and educational status

Name of School Location Agency Province Universities Affiliated or amalgamated with.

Lae SoN Lae Government Morobe Amalgamated with PNGUOT (partially only the program)

Lutheran SoN Madang Lutheran Madang Affiliated with the DWU and affiliation renewed.

Mendi SoN Mendi Government Southern Highlands

Affiliated with UPNG-SOMHS, Taurama Campus

Nazarene CoN Kudjip Nazarene Jiwaka Affiliated with UPNG-SOMHS, Taurama Campus

Highlands College of Nursing

Goroka Government Eastern Highlands

Affiliated to University of Goroka (UOG)

St. Barnabas SoN

Alotau Anglican United Church Catholic

Milne Bay Working towards affiliation with DWU

St. Mary‟s SoN Vunapope/Kokopo

Catholic East New Britain

Affiliated with DWU currently working towards documentation for amalgamation in 2014.

SoHS 14 Mile, PAU SDA Central Amalgamated with PAU. Staff still paid by the NDoH.

Source: Training Data

6.3 The Churches also deliver the pre service and undergraduate nursing programs at

their Schools and College of Nursing. Four (4) Schools and College of Nursing

37

offer the „Diploma Nursing Program while the fifth School delivers the Bachelor in Nursing (4 year‟s Undergraduate Program) at the School of Health Sciences (SOHS) at Pacific Adventist University (PAU). Two out of the five;SOHS amalgamated to PAU deliver the Bachelor Nursing, undergraduate and deliver the Midwifery Program at the same campus similar to Lutheran School of Nursing which offers 3 year DGN program and the Bachelor Midwifery Program.

6.4 The three (3) Government Schools and College of Nursing conduct the three (3) Year Diploma in General Nursing Program (DGN). Table 12 shows the listing of the Nursing Institutions in the country.

Section 7: Training Institutions

7.1: Community Health Workers Schools

7.1 1 Community Health Worker (CHW) Program was introduced in 1985-1987 to

replace the two previous Programs; Aid Post orderly (APO) and the Nurse Aide

programs (NA) which then was a one year Certificate Program. The APO program

prepared the manpower mostly males for the very basic primary care services as the

frontline workers who manned the many Aid Posts (AP) throughout the country,

while the Nurse Aide Program prepared the female and male Nurse Aide Assistants

to support the Nursing professional workers where they were employed in the Health

Sub System facilities and Hospitals.

7.1.2.1The current CHW Program is based on 25 Competency Standards that

accommodates the NHP 2001-2010 Priority Programs and the 'Healthy Island

Approach' being the framework for the program.

7.1.2.1 The Rumginae CHW School located in Rumginae in the North Fly District,

in Kiunga and it is managed by the Evangelical Church of Papua (ECP), the

only School this church Agency manages within the country.

7.1.2.1.1 The School is accessible by the road infrastructure, by airline and river

transportation using the Fly River as the route for the resource accessibility

delivery through to the School. Whilst there is good accessibility, it is very

expensive for transportation.

7.1.2.1.2 The Schools staff positions are all filled and for the School to increase its

output implies that there will be additional infrastructure to do with classrooms,

accommodation for male, female students and staff.

7.1.2.2 Kapuna CHW School is situated in Baimuru area of the gulf province and is

operated by Gulf Christian Health Services. It is a very remote School and

they get their resources by air and sea transport only. The School

infrastructure is built with funding assistance from the NZ Government

there are limited space for expansion. The School is also used as a Health

Centre and managed by the Gulf CHS.

38

7.1.2.3 St. Gerards Veifa‟a CHW School have all the teaching positions filled and

have the capacity to increase however the land that the School is located

is a concern that need to be resolved.

7.1.2.4 St. Margaret CHW School is operated by the Anglican Church and is located

in the Popondetta town-ship.

7.1.2.5 Salamo CHW School is operated by the United Church and is situated on

Ferguesson Island in the Milne Bay Province. It is quite remote on an

island and the School land boundaries are issues if the school is to increase

its intake.

7.1.2.6 Braun CHW School is operated by the Lutheran Health Services and

situated next to the Braun Health Centre in the Finchhafen area. All

Teaching positions are filled and there adequate space however the

Church need to confirm in terms land boundaries between School and

Health centre.

7.1.2.7 Gaubin CHW School located on Karkar Island and managed by the Lutheran

Health Services.

7.1.2.8 Raihu CHW School is located in Aitape and managed by the Catholic

Agency.

7.1.2.9 Lemakot CHW School is annex to Lemakot Health Centre and is managed by

Catholic Health Agency. Land is an issue in regard to expansion there.

7.1.2.10 Kumin CHW Schools situated in Mendi town and is managed by the Catholic

Health Services, has good buildings and resources, but has vacant positions

to be filled first before any expansion can take place.

7.1.2.11 Tinsley CHW School is situated in the Bayer River in Western Highlands

Province and it is located next to the Tinsley Health Centre. All teaching

positions are filled.

7.1.2.12 Onamuga CHW School is situated in the Eastern Highlands Province and

managed by the Salvation Army Church agency. There are positions that

are still vacant there.

Figure 5: CHW Cohort Enrolment/Graduates/Attrition 2007-2012

0

100

200

300

400

500

600

700

2007-20092008-2010

2009-20112010-2012

Enrolments

Graduates

Attritions

39

Table 14: CHW School Diagnostic Audit, 2012

Name of

School

Total

Positions

Staff on

Strength

Vacant

Positions

Total

Population

Staff

Student

Ratio

Teaching

Qualifications

Highest

Qualification

Braun 6 6 0 59 1:8 X1 0

Gaubim 6 4 2 69 1:12 X3 X1 Degree

Lemakot 6 6 0 60 1:10 X4 X1 Degree

Kapuna 6 5 1 40 1:8 X4 X2 Degree

Kumin 6 3 3 41 1:13 X2 X1 Masters

Onamuga 6 5 1 47 1:9 X1 X1 Degree

Raihu 6 5 1 80 1:18 X1 X2 Degrees

Rumginae 6 6 0 47 1:7 X1 0

Tinsley 6 4 2 51 1:8 X3 0

Salamo 6 5 1 50 1:10 X3 0

St. Gerard

Veifa‟a

6 6 0 72 !:12 X2 X1 Degree

St. Margaret 6 4 2 47 1:10 X3 0

Total 72 59 (76%) 13 (24%) 663 1:11 28 8 Degrees, 1

Masters

Source: CHW Schools Diagnostic Audit, 2012

Figure 6: Age Profile for the CHW Educators

There are 13 vacant positions as per the teaching load and staff /student ratio in

some CHWs Training Schools. Increased enrolment will require additional Staff for

all the institutions. The attrition rate over the next 10 years will mean more CHWs

must also be trained to replace those leaving the system.

14

28

64

21-34 35-44 45-54 55-64

CHW

40

7.2 Nursing Schools and Colleges

Nursing Schools and Colleges for Nurse Training:

School of Health Sciences (SOHS) amalgamated with Pacific Adventist University

(PAU) is a model school for Nursing and Midwifery conducted at this University. It

has the Training facility which comes under the school and shared its facility with

other programs at the University. The facility has the internet services for basic

research, computer and clinical lab etc.

St Barnabas School of Nursing is managed by a consortium of churches; United

Church, Anglican Care and Catholic and is situated next to the Alotau General

Hospital but has land problems that should be resolved before any expansion takes

place. The School has yet to affiliate to a University.

Lae School of Nursing is in Lae City and on Angau Drive next to Angau Hospital. Land

is the biggest issue as the school does not have in place the entire basic

infrastructure to operate.

Madang School of Nursing is operated by the Lutheran Church and is situated in the

Madang town-ship near Modilon Provincial Hospital. It is also situated next to the

Divine Word University and is one of the Schools affiliated where the graduates upon

completion of their programs both; Diploma in General Nursing (DGN) and the

Bachelor Clinical Nursing (Midwifery) are awarded by the DWU.

Nazarene College of Nursing (NCoN) is situated in the Mid-Waghi Valley near to

Kudjip Hospital and is under the Nazarene Church. It is in the new Jiwaka Province.

Student‟s practicum experiences are conducted in both Kudjip and Mt Hagen

Hospitals.

St. Marys School of Nursing (SMSoN) IS located in Kokopo Town-ship in East New

Britain Province, and is the only Nursing School in the New Guinea Island Region

(NGI) after the closure of the Arawa School of Nursing due to Bougainville crisis in

1999 and later the closure of Rabaul School of Nursing because of the volcanic

eruption in 1994. SMSON is affiliated with DWU however, it has had its Programs

reviewed but is working towards full amalgamation with DWU in 2014. The School

enrols female students but has plans to recruit male students in future.

Highlands College ofNursing HRCN) situated on the Provincial Hospital grounds and is

closer to the Goroka Base Hospital. It is an affiliated School with the University of

Goroka (UOG) where the University also delivers some of the health related courses

such as the; Bachelor in Maternal Child Health (BMCH)Diploma in Health Teaching

and Diploma in Health Promotion.

Mendi School of Nursing is situated in the Mendi town-ship and near Mendi Hospital.

There is good collaboration and support at all levels for the school by the Hospital

41

and Provincial Health Management including the community. There is academic

sharing of expertise between Mendi SoN and Kumin CHW School.

Figure 7: Nurse Enrolment/Graduates and Attrition from 2006-2012

Table 15: Nursing Training Staff and Profile

Name of

School

Total

Positions

Staff on

Strength

Vacancies Student

Population

Staff

Student

Ratio

Teaching

Qualifications

Degrees Highest

Qualifications

Mendi 12 9 3 96 1:10 6 6 4

HRCN-

Goroka

12 11 1 102 1:9 5 6 1 Masters

Lae 12 11 1 95 1:8 5 9 1 Masters

Lutheran 14 13 1 114 1:8 7 8 3 Masters

Nazarene 13 13 0 73 1:5 3 8 3 Masters

St. Mary,s 12 11 1 96 1:8 5 7 2 Masters

St.

Barnabas

10 8 2 58 1:7 4 6 1 Master

SOHS-PAU 10 6 4 167 1:28 6 6 2 (ongoing

Master on

ground at

Campus)

Total 95 82 (86%) 13 (14%) 801

Source. Training Data

The Staff delivering the programs are highly qualified as they have both their

Teaching and professional qualification.

0

50

100

150

200

250

2006-2009 2007-2010 2008-2011 2009-2012

Enrolments Graduates Attritions

42

Figure 8: Age Profile for the Nurse Educators

Source. Training Data.

Figure 9: Age Comparison between Nurses / CHW Age

Source: Training Data

The Nurse Educators are ageing as compared to those in the CHW Educator

workforce and thereneeds to be succession planning for those educators who

33

5

3

Nurses

45-54

55-64

65+

Key

0

5

10

15

20

25

30

35

21-34 35-44 45-54 55-64 65+

33

53

14

28

64

Nurses CHW

43

will be exiting in ten years while the other 10% are already in the retiree age

group.

Table 16: Inventions for Nursing Schools- 2013.

In order for the Nursing schools to increase their intakes the following are important considerations: 1. Increase capacity in each school on classrooms, library, messing,

dormitories, and auditoriums, new staff accommodations and demonstration labs.

2. All schools need vehicles, boats to support the management of teaching and learning.

3. All schools need extra tutor positions especially in clinical training. 4. Need computer labs with Internet connections for students and link up

Schools 5. Need computers for teaching staff and linkage to Schools for sharing of

information and encourage staff in taking up Research. 6. Need Equipment for teaching and advocate for Attachment Programs and

twining to external universities for skill exchange.. 7. Need upgrades in library books and current government standard treatment

books and use of ICT will address the issue of outdated library books.

HR (ARREST PLAN) INTERVENTIONS FOR NURSING SCHOOLS – May 2013

Schools Needs

Teaching

equipments

Library

Books

(In Kina) (In Kina)

Lae SON 3 1 1 1 2 50,000 50,000 1 2 2 2

Goroka SON 3 1 1 1 2 50,000 50,000 1 2 2 2

Mendi SON 0 1 1 1 2 50,000 50,000 1 2 2 2

Nazarene

SON

3 1 1 1 2 50,000 50,000 1 2 2 2

Lutheran

SON

3 1 1 1 2 50,000 50,000 1 2 2 2

St, Mary

SON

3 1 1 1 2 50,000 50,000 1 5 2 2

St.

Banarbas

3 1 1 1 2 50,000 50,000 1 2 2 2

18 7 7 7 14 350,000 350,000 7 17 14 14

Office

Expansion

Staff

house

Dormitories Extra Staff

position

Classroo

m

Demo

Lab

Auditori

um

Mess

facility

vehicle

44

6.5 Continuing Education and Staff Development Programs. 6.5.1 The Continuing Education in particular for the health professionals is conducted in country and abroad. Table 13 shows the current programs conducted in the country. Table 13: Providers of the Continuing Education and Staff Development Programs

Programs Entry Level

Duration Level of Program

Providers of the Programs

Bachelor Clinical Nursing (Midwifery, Paediatrics, Mental Health and Acute Care) (BCN)

1 Degree SOMHS, Taurama Campus

Bachelor Nursing (BN ) Education and Nursing Administration

1 Degree

Bachelor Nursing (CHNA) 1 Degree

Bachelor in Public Health 1 Degree

Diploma in Eye Care 1 Degree Divine Word University

Bachelor Midwifery 1 Degree Lutheran SON accredited by DWU

Bachelor Midwifery 1 Degree Pacific Adventist University (PAU)

Bachelor of Midwifery 1 Degree University of Goroka(UOG)

Diploma in Health Teaching 1 Diploma UOG

Diploma in Health Promotion 1 Diploma UOG

Source: Training Data

6.5.2 The Graduates of the Programs in particular; nurse midwives, paediatric nurses, public health officers and the mental health nurses take up employment at rural health facilities at Provincial and District offices, Health centres, sub centres etc.

Training Data for other Undergraduate and Continuing Education by the

Universities

Figure 10: Enrolments of MBBS & Programs AHW by UPNG.

45

Figure 11: Enrolments of RHEO & Programs by DWU

Figure 12 : Summary of BN ,BCN & DCH

2007

2008

200920102011

0

10

20

30

40

50

2007 2008 2009 2010 2011

2006

2007

2008

0

10

20

30

40

50

60

70

2006

2007

2008

46

Figure 12: Summary of BN, BCN and DCH

6.6 In Service Programs

6.6.1 The District Health Supervisor or Principal Advisor in the provinces has a role in overseeing that in -service training on health priority programs and the Millennium Development Goal related are addressed by the health workers in the field. Typical Program includes the following:-

6.7.1.1 Reproductive health - 10 step checklist for assessment of pregnant mothers and identify those at risk to deliver at health facilities,

6.7.1.2 Child Health - Integrated Management of Childhood illness (IMCI) etc 6.7.1.3 Communicable Diseases such as; TB, Malaria, HIV/Aids 6.7.1.4 Immunization services 6.7.1.5 Health Promotion and Health Awareness programs on Healthy Communities 6.7.1.6 Others 6.8 Training Issues and Challenges

6.8.1 There are important constraints and challenges to training development within the health sector.

6.8.1.1 Lack of good training information system for managerial decision making

at all levels for coordination of training at all levels, National, Provincial and District level. Hence there is no training plan.

6.8.1.2 Further to this, there is lack of proper information on the training programs conducted in –country and abroad and eligibility to be available

0

10

20

30

40

50

60

70

80

2007 2008 2009 2010 2011

BN

BCN

DCH

47

at all levels through various offices such as Provincial and District HR for those individuals applying for the programs.

6.8.1.3 Lack of Monitoring and evaluation process to ensure officers who complete programs are utilized and assisted to apply knowledge in work setting.

6.8.1.4 Lack of In Service Training systems and structure in particular at the Provincial and the District level. Hence there is no compulsory in service training with leads to career progression for individuals in clinical, management etc.

6.8.1.5 Lack of good training infrastructure facilities such as clinical labs for practice, teaching and learning resources for the pre service programs.

6.8.1.6 Lack of linkages of Institutions through use of Information and computers and technology where through such would facilitate information and knowledge sharing between Schools thus would cut down the cost of purchasing library books.

6.8.1.7 Inability for Institutions to expand due to ownership of land matters between landowners, and State such as the Hospitals.eg Lae School of Nursing in Morobe Province, ST. Barnabas SON in Milne Bay, St. Marys SON, Kokopo, Nazarene and Highlands College of Nursing in Jiwaka and Eastern Highlands Provinces.

6.8.1.8 The performance appraisal tied to performance of individual/team in improving health indicators.

6.8.1.9 There are no training programs developed for Health Support Staff like Nutritionist, Biomedical Engineers, and Medical Recorders etc.

Section 8:Indicative Costing

In developing and designing the National Department of Health long term workforce

plan it is imperative to understand the context of the human resources capacity and

how it will response to implementing the National Health Plan 2011-2020, policies

and legislations.

The call to develop an urgent Health Workforce Plan ( - Arrest Plan) has allowed all

concerned in the country and partners to significantly contribute to the analyses of

the issues such as current health workforce, partners contributions, training

responsibilities, programmes, infrastructure, institutions and human resources

availability to implement the Arrest plan.

The challenge of treating the above issues and risks will require short to long term

financial resources and commitment by the Government and its partners to urgently

jump start the Arrest Plan.

Table 17 provides a summary of the training manpower projection under the Arrest

Plan and with indicative financial budget support the implementation of the Plan

from 2013-2016.

48

The Arrest plan will require approximately K50, 407,000.00 and target over 5,110

workforce/manpower to be available to support the implementation of the short

term plan and contribute to the long term plan.

Manpower and costing by year can be summarised as:

Year Workforce Cost

2013-2014 1,545 K26,414,000

2015 1,704 K13,696,000

2016 1,761 K14,196,500

Total 5,010 K50,407,000

The data and information collected and published in this report has made it possible

to determine manpower requirements and estimate the costing of the Arrest Plan.

The details of the summary on the workforce requirements, costs per year has been

drawn from the Table 17.

In planning and budgeting for the Arrest Plan, Table 17 has been inserted directly

into Plan under section 6.7.

TABLE 17: Projection of Training Manpower Requirements

MANPOWER PROJECTION & INDICATIVE COSTING

SUMMARY: PROJECTED MANPOWER & COSTING OF THE ARREST PLAN

CADRE

TYPE 2013-14 2015 2016 TOTAL

Community Health Workers

Trainees 250 375 375 1000

Sub Total 250 375 375 1000

Costing K1 M K1 .5 M K1.5 M K4 M

Village Birth Attendants &

Village Health Volunteers

Trainees

250 375 375 1000

49

Sub Total 250 375 375 1000

Costing K750,000.0 K1,125,000.0 K1,125,000.0 K2.250,750.0

NURSES (All)

Trainees 100 150 150 400

NIP 0 0 0 0

Scholarship 10 20 20 50

Sub Total 110 170 170 450

Costing 400,000.0 600,000.0 600,000.0 K1.6 M

Health Extension Officers

Trainees 50 150 150 350

Scholarship 5 5 10 20

Non-Inst. Positions 50 Carry Carry 50

Sub Total 105 155 160 420

Costing 1,511,050.0 937,500.0 937,500.0 3,386,050.0

Medical Officers (All)

Trainees 100 250 250 600

Scholarship 10 20 20 50

Non-Inst. Positions 400 Carry Carry 400

Sub Total 510 270 270 1050

Costing 12,654,400.0 7,409,000.0 7,409,000.0 27,472,400.00

Allied Health Workers

Trainees 50 150 150 350

Scholarship 10 20 20 50

Non-Inst.

Positions 50 Carry Carry 50

Sub Total

110

170 170 450

Costing 1,448,550.0 750,000.0 750,000.0 2,998,555.00

Trainees 50 75 75 200

50

Section 9:Concluding Remarks

Summary

We consider it very important to have this document available to support the recommendations made

in the Arrest Plan 2013 – 2016. This ‘Supporting Evidence document’ providesimportant data and

information about the Health Sector Human Resource Management and the training institutions that

trains the Health Workforce.

This report provides an important foundation of data and information to support the monitoring and

evaluation of the Arrest Plan. In addition it will assist Health Department for further discussions and

debate on health workforce development in the country as a long term with all its partners.

Health Support Staff

Scholarship 5 7 8 20

Non-Inst.

Positions 0 0 0 0

Sub Total 55 82 83 220

Costing 250,000.0 375,000.0 375,000.0 K1 M

District Health In Service

Coordinators

Public Service

Positions to be

created for the

Department 100 Carry Carry 100

Sub Total 100 Carry Carry 100

Costing K 4 M 0 0 K4 M

Management Officers

Non –Inst.

Positions

(Training)

50 100 150 300

Scholarship 5 7 8 20

Sub Total 55 107 158 320

Costing 500,000.00 K1 M K 1.5 M K2 M

TOTAL MANPOWER

1,545 1,704 1,761 5010

TOTAL COSTING

K26,

414,000.0 K13,696,500.0

K14,

196,500.0 K54,307,000.0

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The information we have captured in this document relates to the policy and legal framework; the

current health workforce status of the national health system; data and information provided by the

Christian Health Services for all church operated health facilities in the country; Training responsibility,

Training Programs and Training Issues; The Training Institutions; and costing elements of the Plan.

Majority of the information we have include have come from a number of sources and contacts:

Provincial Health Administration;

Provincial Hospitals;

Regional Hospitals

Referral Hospital

Community Health Workers Training Schools

Nursing Colleges and Schools

PNG Universities

The Medical Board and Nursing Association

World Bank Health Report 201

Nationa1 Health Plan 2011 2020

National Department of Health

Australia Government Report 2010

All the above Agencies have contributed to the data and information presented in this document.

ATTACHMENTS: DATA AND INFORMATION SOURCES

The following attachments and information (Policy, Reports, Submissions) provided

by the stakeholders were used to complete the Arrest Plan 2013 -2016

I. Human Resource Management Policy of NDoH

II. Professional Medical Standards

III. Medical Standards

IV. World Bank Report – Health Workforce Crisis “A Call to Action” October 2011

V. Access Status of Health Facility Services – PNG

VI. Training Policies for Vacancies for various cadre of Medical Officers (2014 and beyond):- By the Medical Board of PNG

VII. CHWs Schools Diagnostics Audit 2012

VIII. PNG Capacity Nursing Schools Diagnostics Audit

IX. Templates used to collect information from Hospitals, Institutions & PHA

X. Health Workforce Plan Workshop

XI. Baseline Data Report 2009 /2010

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XII. Regulatory Authorities

XIII. National Health Plan 2011 - 2020