Can the ADB solve the corruption crippling PNG’s health system?

The Asian Development Bank says it will assist Papua New Guinea address the systemic failings in its health system through a new $195 million program, but can this externally driven project successfully address the chronic problems of corruption and mismanagement in the sector?

Over the last ten months PNGi has repeatedly exposed the the systemic problems in the procurement and supply of medicines in PNG that is ultimately causing unnecessary deaths and incalculable suffering across the country. Profiting from Sickness Part 1, Part 2, and  Part 3 focused attention on the abusive commercial transactions that are leading to the circulation of overpriced and substandard medical goods in our hospitals, health centres and aid posts, while Part 4 looked in detail at the problems on the logistics side of the supply chain.

In one instance, a senior Health Department official is alleged to have been paid more than K250,000 to facilitate payments to a logistics company involved in distributing medical kits. Despite the clear documented evidence of the payments, no action has been taken by the Health Secretary to refer the matter to the police.

In another, a service provider with a history of ‘poor performance’, whose ‘deliveries have been delayed by months’, who overcharges and  refuses, in some instances, to provide proof that deliveries have actually been made, is continually ‘rewarded’ with new contracts while the NDOH refuses to take any steps to monitor the company’s performance. 

In such circumstances, can the ADB’s new program, funded by $195 million in loans, ‘to support the delivery of accessible, affordable, and high-quality health services’ really make a difference?

On the positive side, the ADB has publicly highlighted ‘weaknesses in government systems’ as a main cause of deteriorating healthcare services and says ’suboptimal health sector governance’ is undermining service delivery and as a result its program will ’support critical sector reforms’ and ‘deficiencies in governance’.

‘Weaknesses in systems’ and ’suboptimal governance’ are code words for corruption, but acknowledging the problems doesn’t mean they can be successfully addressed and less optimistic is the fact the ADB says its new program ‘builds on the Bank’s long-term engagement in PNG in the health sector’.

If the current deplorable situation has come about with the ADB, along with multiple other international agencies, already involved, what hope is there they can now solve the crisis?

This is particularly true when there is still no acknowledgement from the Health Secretary or his Minister that the problems even exist.

In today’s media health workers are calling for drastic changes as hospital shelves again run bare and ‘some hospitals are completely out of drugs and testing kits; others are scrounging for stocks of life saving drugs like antiretrovirals; some remote health centres have closed altogether’. Yet two days ago the Health Minister, Puka Temu, was proclaiming the country’s health standards are improving! 

Banner image from the Post Courier newspaper, 4 June 2018

Remember, this is a Minister who has been stalling for eight-months on implementing reforms, identified in a confidential government audit, to tackle the critical failings in the supply of medicines and medical supplies.

As PNGi revealed in February,  the audit revealed widespread failures throughout the medical supply and distribution chain which, it claimed, have persisted and not been addressed over several years.

“the problems of weak institutional capacities, high costs, delays, non-compliance with mandatory applicable laws, errors, and high integrity risks are systemic in NDoH. These legendary issues and challenges have remained unaddressed over the last 4 years causing continued deterioration of [sic] unavailability of life saving and essential drugs to treat patients at the health facilities throughout the country”. [Audit Report p3]

The audit revealed widespread opportunities for fraud, overpayments to contractors totalling as much as K80 million a year, and delays in orders and distribution which can last not just months but years. It also revealed widespread violation of proper management and accounting principles within the NDoH and a complete failure to monitor the performance of companies on multi-million kina contracts.

But such revelations were not new. In 2013, a Burnet Institute evaluation and later a 2016 a USAid report revealed the same widespread problems involving many of the same companies and managers.

So, not only is corruption and mismanagement preventing any improvements in health care delivery, they have already frustrated the considerable efforts of international agencies and the dedication of many front line clinical staff. This is because of a failure by our leaders to even acknowledge, let alone tackle, the problems.

As the new ADB project is being driven from outside but will be forced to work with the existing Minister and senior management it seems hard to argue with the final comment at the very end of today’s Radio New Zealand report that, ‘there seems little prospect for change’.

And remember, the price of failure will be borne by us all, not only as the victims of a failed health system but as the taxpayers who must ultimately repay the ADB’s $195 million loan.