Pascoe Kase: The man in charge of a national tragedy

Papua New Guinea’s Health Secretary, Pascoe Kase is the man at the helm of a health system that is in crisis and a human tragedy of epic proportions.

Regular shortages of medicines and other medical supplies have created a dire situation in rural areas according to UNICEF. In January it was was reported* pregnant mothers in Lae were having to buy their own vicryl stitches for caesarian operations, while 24 children died in Morobe without access to medicines or health care and in February 10 infants died in one outbreak of whooping cough because of a lack of immunisations. Health workers say there is a chronic shortage of medicines, and some remote areas lack any health services. As a consequence, it is said patients are forced to buy back market drugs from unlicensed sellers or seek ‘backyard’ cures. Patients are also being turned away from some hospitals according to media reports while health centres are being closed, a situation the shadow health minister has described as ‘an act of genocide’ and a crime against humanity.

Even the United Nations human rights chief has recently weighed in, criticising the government for ‘acute malnutrition rates in some areas comparable to Yemen and minimal access to quality healthcare’.

Backing up these headlines are PNG’s health statistics, which, according to World Vision, are some of the worst in the world:

• Life expectancy at birth is just 63 years compared to 83 years in Australia and 72 years in Vanuatu;
• The under five mortality rate of 58 per 1000 live births is 11 times higher than in Australia and the worst of any Pacific country;
• PNG has only 51 doctors working outside the capital and an average of 1 doctor for every 17,068 people (1 to every 302 people in Australia);
• Easily preventable diseases such as diarrhoea and cholera are major causes of illness and death.

These statistics put Papua New Guinea on a par with the worst end of Sub-Saharan Africa, no other Pacific nation comes anywhere close.

But statistics do not reveal the real human tragedy; they do not show the mothers, babies, children and grandparents who are suffering and dying unnecessarily all across the country, because of the fraud, corruption, profiteering, mismanagement, and incompetency that is rife in our health system.

A confidential special audit into the procurement and distribution of medicines and medical products ordered by the Prime Minister and conducted by the staff in his own Department, has detailed ‘legacy issues’ of mismanagement and abuse in the National Department of Health that have not been addressed over many years.

Pascoe Kase has been in charge of the Department since 2012; he was reappointed Health Secretary for a second four-year term in February 2016.

The audit report says the issues that it highlights have been well known internally in the Department for years, but have not been addressed.

Responsibility for that must surely lie at the door of the Health Secretary?

According to the Prime Minister’s audit team, under Kase’s management, the Health Department has:

• Wasted as much as K80 million a year on overpriced drugs
• Failed to monitor the performance of drug supply and distribution companies engaged under multi-million kina contracts
• Failed to tender new contracts on-time or at all
• Instructed Area Medical Stores to receipt drugs that have never arrived
• Routinely breached the Public Finance Management Act by, for example, ordering drugs and paying invoices without any accompanying Purchase Order
• Failed to check if invoice amounts match contractually agreed prices
• Failed to monitor or chase outstanding orders – which totalled some K184 million at the time of the audit
• Failed to penalise suppliers or distributors for late deliveries
• Paid extra for emergency or ‘rush’ orders, some of which took months to arrive
• Failed to implement reforms recommended in earlier reports
• Failed to ensure suppliers maintain buffer stocks so orders can be dispatched promptly
• Sent unwanted or close to expired drugs and other medical products out to Area Medical Stores and health facilities
• Failed to do proper planning, forecasting and accurate record keeping resulting ‘in paying very high prices to the suppliers’
• Failed to investigate complaints, including corruption allegations against a very senior officer, and so the list goes on…

If these findings are correct, and given they come from the Internal Audit Branch of the Department of the Prime Minister and NEC, that seems highly likely, then they provide a damning indictment of NDOH and its senior management.

Pascoe Kase is not a man who usually shies away from the media. Last year, for example, he variously denied the serious problems with medicine procurement and distribution, promised to remedy the drug shortages, and gave assurances they had been addressed; all the while, awarding new contracts to, and publicly defending, companies, who, according to the audit, have a track record of failure or abuse.

Just weeks ago, Kase was prominently featured in the media heralding the arrival of a new batch of medical kits into the country – kits the audit says will not match the needs of individual health centres and aid posts and will little to ease the chronic problems.

The ability of the Health Secretary to swim above the chaotic picture painted in the Prime Minister’s audit report with, seemingly, no accountability should be seen in the context of previous PNGi investigations into the health sector.

In the series, Profiting from Sickness, [Part 1, Part 2, Part 3, Part 4] PNGi looked deeply at some of the abusive commercial transactions that are contributing to the circulation of overpriced and sometimes substandard medical goods. Those investigations revealed the wider networks around the largest drug supplier, Borneo Pacific, a company that has been paid more than K200 million by the government over the past four years, and how it is interlinked with elite circles of medical professionals, business people and political figures.

If we now add to those earlier findings the results of the Prime Minister’s audit, and we take those as being accurate, then we can start to see an even broader picture in which it could appear politicians are actively protecting senior bureaucrats who are themselves overseeing a system that has become corrupted both from within and externally.

* Unfortunately hyper-links to the Post Courier newspaper are not accessible to readers in PNG. This is a general restriction imposed by the Post Courier which doesn’t allow PNG residents online access to the publication.