Appendix 2: Accountability and teamwork statement by health sector leaders
This statement has been crafted and agreed by the technical group who developed the ARB Plan for Health.
We will focus on results now and avoid excuses
We will be measured by what we deliver and the way it benefits the people of ARB. Performance will be measured quarterly by the Minister. We accept and expect both rewards and sanctions based on our performance against recognised indicators and benchmarks.
Teamwork strong cross-government and cross agency collaboration
Our priorities, the delivery of ARB plan for Health, require contributions from across government (GoPNG, Buka Hospital, and Rural Health Division) and across partners, including church, donor and private.
We will work based on our contribution to these priorities, not our institutional boundaries, and push each other to speed up delivery.
We will form and resource time-limited cross-organisational teams when the task requires it and take responsibility for the whole team’s performance.
Improved communication
Successful communication is critical to our success. Responsibility for proactive communication, sharing information and strengthening working synergies will be part of our working culture.
A proactive approach
We are all responsible for identifying solutions, not waiting for others to provide them. We will improve both our planning processes and implementation.
We will commit annually to a level of service improvement in any given year for each region and accept independent assessment of the effectiveness of our performance and the reasons for good and poor performance. Independent assessment will include a process where communities evaluate our performance.
We will also accept rewards and sanctions based on this performance assessment.
Signed:
Appendix 3: Strategies in detail ABG Goal: Better management, effective programs and healthier communities
(See ABG’s Medium Term Development Plan (MTDP) 2011-2015, page 131)
There are nine strategies to achieve the goal of better management, effective programs and healthier communities. They are set out in detail below.
No. | Sector Strategy3 |
1
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Improve service delivery
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2
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Strengthen partnership and coordination with stakeholders
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3
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Strengthen health systems and governance
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4
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Improve child survival
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5
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Improve maternal health
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6
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Reduce the burden of communicable diseases
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7
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Promote healthier lifestyles
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8
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Improve preparedness for disease outbreaks and emerging population health issues
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9
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The ABG and GoPNG work together to promote a solid basis for an Autonomous Bougainville health system
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Sector strategy 1: Improve service delivery
Objectives | Strategies |
1.1 Increase access to quality health services for the rural majority.
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Expand BHCP into all districts and introduce village health treasury concept as a way of empowering communities to address sustainability of Bougainville healthy community program.
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Conduct integrated outreach to ensure 95% population coverage for Maternal Child Health and disease control.
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Remove user fees and decentralize funding through Direct Facilities Funding for operational activities at all health centres (HCs), health subcentres (HSCs) and community health posts (CHPs).
-
Provide 24 hour access to transport from all HCs to hospitals for emergencies.
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1.2 Rehabilitate and strengthen PHC and hospital infrastructure and equipment.
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1.2.1 Rationalize best locations and type of health facilities based on an assessment of the population served and travel time.
1.2.2 Rehabilitate or establish rural health infrastructure including:
CHPs and HCs resourced to deliver maternal and child health services
health promotion activities for populations over 3,000 people.
1.2.3 Rehabilitate essential equipment (furniture, medical equipment, non-medical equipment, refrigeration, static plant, power and water supply, communications) at HCs, rural, district and referral hospitals. All equipement should meet PNG health standards.
1.2.4 Establish district hospitals in Arawa and Buin.
1.2.5 Establish regional hospitals resourced to provide quality health care.
1.2.6 Establish a major referral hospital for Bougainville.
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1.3 The right health professionals work in the right places, are motivated, and deliver right (quality) services.
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1.3.1 Develop a human resource implementation plan for ABG. Focus the plan on increasing the numbers of doctors, nurses, midwives, community health workers, allied health workers and health managers and a human resource information system (HRIS).
1.3.2 Determine the distribution and activity levels of the current workforce. Prioritize to place the right people with right skills to provide the most effective delivery of health services for Bougainville as a whole.
1.3.3 Develop training needs assessment and deliver training for current and future HHR including developing CHW and NO training schools.
1.3.4 Ensure regular clinical and management supervision by personnel trained in supervision to HCs, HSCs and CHPs, based on checklists and health standards.
1.3.5 Increase staff ceilings for critical health workers and progressively place medical doctors and visiting specialists in district hospitals and high volume HCs.
1.3.6 Develop and implement affordable health sector workforce recruitment, retention and incentive strategies.
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1.4 Promote easy access to safe and effective forms of traditional medicine and practices as part of the ARB health system.
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1.4.1 Compile and keep updated an inventory of safe and effective herbal medicines used in Bougainville. Publish the inventory as a booklet.
1.4.2 Develop a quality assurance system for herbal medicines and practitioners.
1.4.3 Develop techniques for the production and preservation of herbal medicines.
1.4.4 Train traditional medical practitioners (TMPs) and traditional birth attendants (TBAs) in primary health care.
1.4.5 Encourage collaboration between primary health care providers and TMPs and the sharing of knowledge. Trial the sharing of premises (aid posts) and the development of medicinal herb gardens at HCs and primary schools.
1.4.6 Strengthen the Bougainville Traditional Healers’ Association (BouTHA) through management support and training.
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|
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Performance indicator
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No 21 Outpatient visits per person per year
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Sector strategy 2: Strengthen partnership and coordination with stakeholders
Objectives | Objectives |
2.1 The health sector works collaboratively with all stakeholders to expand the reach of quality health services.
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Develop the Bougainville Health Board to coordinate health development.
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Establish and strengthen the Bougainville Churches Medical Council.
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Engage community-based organizations in planning, delivering and evaluating health services.
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Merge BHCP into the mainstream health system.
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Enhance communication, cooperation, reporting and coordination with central agencies and other Bougainville sectoral departments, especially with the Departments of Treasury, Planning, Finance and Provincial and Local Level Government.
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2.2 Implement ABG public private partnerships policy and introduce innovative and cost effective options for delivering services.
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2.2.1 Enter into agreements with extractive industries to reduce health impact and agree mitigation measures before mining operations begin.
2.2.2 Include private health providers in the health sector coordinating body.
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Sector strategy 3: Strengthen health systems and governance
Objectives | Strategies |
3.1 Improve financial resourcing and management for health service delivery.
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Develop and agree a funding envelope to 2020 with GoPNG, ABG, donors. Integrate income streams into single health funding facility. Construct ABG health accounts.
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3.2 Medical supply procurement and distribution services are efficient and accountable.
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3.2.1 Assess the feasibility of ABG procuring its own medical supplies and the delegation of Pharmaceutical Board responsibilities.
3.2.2 Develop a ‘Pull’ system for medical supplies management for all HCs, HSCs, CHPs.
3.2.3 Merge hospital and rural health services medical supplies systems.
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3.3 The health sector proactively identifies and uses innovative and evolving ICT solutions and delivers accurate and timely information for planning and decision making.
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3.3.1 Develop a timely, autonomous and flexible health sector management information system across all layers and institutions of the ARB health system linked to a national patient master index.
3.3.2 Build the capacity of ABG health information officers and hospital medical records officers to compile, analyse, and provide quality information for district and hospital management.
3.3.3 Increase the use of mobile phones for data collection and transfer.
3.3.4 Ensure all health sector providers including the private sector support ARB and national health surveillance systems.
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3.4 The Minister for Health is supported by an external advisory group which monitors the implementation of the Bougainville Health Plan.
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3.4.1 Ensure all stakeholders receiving Government of Papua New Guinea, health development partner or ABG funding are guided by the Bougainville Health Plan and comply with relevant legislation. Ensure stakeholders provide an audited annual report, including proposed future programming and expenditure.
3.4.2 The Minister of Health holds the CEO Health accountable for the delivery of services in accordance with relevant legislation and the Bougainville Health Plan.
3.4.3 Strengthen the performance monitoring and evaluation framework, by linking information about and reporting on performance, HR and financial resources.
3.4.4 Planning, budgets, expenditure and management decisions are linked to health priorities and evidence-based. Business cases are prepared for all projects exceeding PNGK1 million.
3.4.5 Ensure committees such as the Bougainville Health Board, Audit Committee, Professional and Pharmaceutical Board (if devolved) implement quality assurance programs and meet reporting requirements in compliance with legislation.
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Sector strategy 4: Improve child survival
Objectives | Strategies |
4.1 Increase coverage of childhood immunization in Bougainville.
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4.1.1 Ensure every facility, every day, at every encounter immunizes children when indicated.
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4.2 Reduce case fatality rates for pneumonia in children by speeding up the roll out of integrated management of childhood illnesses (IMCI) to Bougainville.
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4.2.1 Build the capacity and capability of all HCs and CHPs to implement IMCI.
4.2.2 Increase the percentage of communities with the capacity to implement IMCI in conjunction with BCHP.
4.2.3 Introduce cost effective vaccines, such as pneumococcal vaccine.
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4.3 Decrease neonatal deaths.
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4.3.1 Ensure all HCs and CHPs have the capacity to provide life-saving support to the neonate.
4.3.2 Ensure 99% coverage of tetanus toxoid for antenatal mothers.
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4.4 Reduce malnutrition (moderate to high) in children under the age of five years.
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4.4.1 Adopt the ‘First 1000 Days’ strategy.
4.4.2 Support the continuation of exclusive breastfeeding.
4.4.3 Ensure all babies and children under five have access to supplementary feeding when and where they require it.
4.4.4 Increase access for mothers and children to micronutrient supplementation.
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Performance indicators
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No2 Childhood malnutrition
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No9a Measles immunization coverage for children under 1 year
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No 9b Third dose TA/pentavalent coverage
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Sector strategy 5: Improve maternal health
Objectives | Strategies |
5.1 Increase family planning coverage.
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5.1.1 Ensure every health facility has the capacity to offer family planning services at all times.
5.1.2 Advocate for the advantages of having fewer children and increased spacing of children.
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5.2 Increase the capacity of the health sector to provide safe and supervised deliveries.
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5.2.1 Increase the number of facilities capable of providing supervised deliveries.
5.2.2 Increase the numbers of health workers skilled in obstetric care.
5.2.3 Ensure every maternal death (in health facility and in community) is reported, investigated and audited. Ensure that practices improve as a result. Report maternal deaths to the Minister of Health on a monthly basis.
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5.3 Improve access to emergency obstetric care (EOC).
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5.3.1 Increase the capacity of all HCs and CHPs to provide essential EOC.
5.3.2 Ensure all high-volume facilities are capable of providing comprehensive obstetric care.
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5.4 Improve sexual and reproductive health for adolescents.
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5.4.1 Increase the knowledge of adolescents about sexual and reproductive health.
5.4.2 Increase cross-sectoral collaboration with schools to strengthen education of students in sexual and reproductive health.
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Performance indicators
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No 10A Proportion of supervised births at health facilities
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No 11 Antenatal coverage
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No 12 Family planning use
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Sector strategy 6: Reduce the burden of communicable diseases
Objectives | Strategies |
6.1 Reduce malaria-related morbidity and mortality in Bougainville.
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6.1.1 Galvanize political commitment for malaria control through setting a goal and an implementation plan for malaria elimination.
6.1.2 Provide households with long-lasting insecticide-treated nets (LLIN) to cover all usual sleeping places, and reintroduce residual spraying where appropriate.
6.1.3 Maximize access to prompt quality diagnosis and appropriate treatment for malaria.
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6.2 Control tuberculosis (TB) incidence by 2020, with a decline in cases of multi-drug-resistant tuberculosis (MDR-TB).
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6.2.1 Ensure all TB cases have access to tuberculosis directly observed treatment, short-course (TB DOTS).
6.2.2 Provide HIV counseling and testing for all TB cases.
6.2.3 Strengthen, integrate and implement TB and HIV collaboration.
6.2.4 Work with ABG to develop an intersectoral approach to improving the indoor environment of domestic dwellings.
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|
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6.3 Scale up prevention, treatment, care and, support for sexually transmitted infections (STIs) and HIV to meet universal access targets.
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6.3.1 Increase access to quality HIV counseling and testing services including prevention of parent-to-child transmission (PPTCT) counseling.
6.3.2 Increase access to quality antiretroviral (ARV) treatment for adults and children.
6.3.3 Ensure male and female condoms (and lubricants) are available and accessible throughout Bougainville.
6.3.4 Increase access to post-exposure prophylaxis (PEP) services.
6.3.5 Strengthen syndromic management of STIs.
6.3.6 Increase the knowledge of adolescents about sexual and reproductive health.
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6.4 Strengthen communicable disease surveillance and monitoring.
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6.4.1 Introduce an integrated surveillance and monitoring strategy for cholera, emerging diseases, neglected tropical diseases, hookworm, leprosy and other infectious diseases.
6.4.2 Strengthen epidemic surveillance and response capacity for communicable diseases with a potential for outbreaks.
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|
|
Performance indicator
|
No 4 Malaria incidence per 1000 population
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Sector strategy 7: Promote healthy lifestyles
Objectives | Strategies |
7.1 Increase health sector response to the prevention of injuries, trauma, and violence.
|
7.1.1 Increase population-based programs designed to reduce the number of preventable injuries and trauma.
7.1.2 Increase the roll out of and access to family support centres.
7.1.3 Increase and build adequate capacity of hospital accident and emergency departments to address transport-related injuries. This applies to the existing and two proposed hospitals as well as the proposed new referral hospital.
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7.2 Reduce the number of outbreaks of food and water-borne diseases.
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7.2.1 Establish water management committees to manage and control rural water supplies and sanitation.
7.2.2 Increase the number of households that have access to safe drinking water, and effective waste disposal and sanitation.
7.2.3 Ensure all health facilities have access to running water, and effective waste disposal and sanitation.
7.2.4 Ensure public and private buildings comply with legislation in relation to water supply, sanitation, and food handling.
7.2.5 Review and improve relevant legislation to enhance the management and control of rural water supplies.
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7.3 Reduce morbidity and mortality from non-communicable diseases.
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7.3.1 Increase the focus on population-based health interventions designed to reduce the impact of substance abuse and excessive alcohol use, including home brew. Promote increased levels of physical activity and improved diet.
7.3.2 Implement population-wide early detection (screening) and immediate clinical interventions for non-communicable diseases, such as heart disease, strokes, diabetes, and cancers with an initial focus on cervical cancer.
7.3.3 Support employers in ARB to promote healthy diet, opportunities for regular physical activity and smoke-free working environments.
7.3.4 Review and improve legislation that will support tobacco control, and reduce the sales and marketing of drinks and foods high in fat, salt and sugar.
7.3.5 Improve and expand mental health services to address a range of mental health issues, including post-traumatic stress disorder.
7.3.6 Improve disability and community-based rehabilitation services.
7.3.7 Ensure all public and private sector employees routinely undergo medical examinations for the early detection of lifestyle diseases.
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|
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Performance indicator
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No 6 Diarrhoeal disease in children less than 5 years
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No 7 Injuries reported at outpatients per 100 population
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Sector strategy 8: Improve preparedness for disease outbreaks and emerging population health issues
Objectives | Strategies |
8.1 Increase capacity of the health sector to identify, monitor, report on and respond to urgent and emerging health threats.
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8.1.1 Strengthen capacity of the health sector to report on notifiable diseases in accordance with international regulations. Increase the capacity of ARB to coordinate their responses to epidemic and population health emergencies.
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8.2 Establish Bougainville Public Health Laboratory (BPHL) function to provide services to meet urgent and emerging concerns.
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8.2.1 Extend the functions of the current Buka Hospital laboratory to include public health laboratory functions. Ensure it has sufficient capacity and supplies at all times to respond to disease outbreaks and other emergency health concerns.
8.2.2 Ensure a functioning and safe blood transfusion service is available to the health sector and includes HIV blood screening capability.
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8.3 Improve capacity and preparedness of the health sector to address the impacts of climate change.
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8.3.1 Actively engage in the resettlement process for climate change refugees to ensure their health needs are met.
8.3.2 Ensure every health facility has a disaster preparedness plan, which includes issues associated with climate change.
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8.4 Ensure the health sector works collaboratively to manage population health threats related to the growing resources boom.
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8.4.1 Develop an appropriate response to the health impacts of mercury and arsenic on miners and their families in the Panguna Basin.
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Sector strategy 9: The ABG and GoPNG work together to promote a solid basis for an autonomous Bougainville health system
Objectives | Strategies |
9.1 Facilitate MOU on drawdown of health functions and powers from NDOH to ABG DoH.
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9.1.1 National Government and ABG sign MOU.
9.1.2 Develop concept proposal on Bougainville Health Authority (BHA) and commence legislative review.
9.1.3 Agree legislative framework for BHA with the national government.
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9.2 Create Bougainville Health Authority.
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9.2.1 Develop policy and legislative provisions to form the BHA.
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9.3 Implement Bougainville Health Plan.
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9.3.1 Establish and convene an independent advisory group to advise the Minister on the implementation of the Bougainville Health Plan.
9.3.2 Report annually to the ABG parliament on the progress in implementing the Bougainville Health Plan.
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