Public health: A hard journey of renewal in Papua New Guinea

In a small conference room at the  Headquarters of the National Department of Health (NDOH)  in Port Moresby, a group of   Papua New Guinean public health experts resume the mentally gruelling process of  creating the  country’s Public Health Policy.

This policy will complement the Public Health Act of 1973 which will itself later be reviewed and updated.  When the act was put into effect by the colonial administration,  it was done so without an overarching policy.

In March, 2020, when Papua New Guinea recorded its first COVID-19 case, the government found serious inadequacies in the existing legislations.  The  Public Health Act (1973) and the Quarantine Act (1952) and the absence of  guiding policy complicated efforts. 

As the emergency progressed, the government found it necessary to pass a new law – the National Pandemic Act of 2020 which addressed the movement of people, security and the medical emergency itself.

COVID-19 challenged definitions of ‘public health’ and ‘public health emergency.’ It challenged and tested the NDOH’s ability to handle a health emergency of unprecedented magnitude.

Government policy experts found that they needed to rethink how a health related  public emergency should be addressed in future taking into account aspect of security, quarantine

Defining Public Health in the PNG context

In policy development, the definitions of words are central to the document’s intent. 

Appropriate definitions ensure that the implementation  of laws are accurate and  legal and other risks are mitigated before the document even comes into effect.

Over the next four hours, the team wrangles  over the meaning of the words ‘Public Health’ in the Papua New Guinea context.

What does it mean? Should it include safety? What should it cover? Food? Markets? Buai? Tobacco?  Fees? Penalties?

They’re all important questions and capturing them all into one policy statement and then into  one document is a challenge. The team has been working on the development of the policy for several months.  This work has to be completed before the Public Health Act of 1973 is reviewed and amended for tabling in Parliament.

In a  concept paper presented to the team for discussion, it said “PNG is yet to define what ‘Public Health’ means for its people.”   It is a profound statement.

As complex as Papua New Guinea is, the definitions have to be suited for the people and easy  to use by  the implementors of the policy and its primary custodian – the National Department of Health.

The work being done now  complements ongoing policy and legislative reforms  that the NDOH has been working on over the last three years under the leadership of Health Secretary,  Dr. Osborne Liko. It is guided by the newly created National Health Plan.

Alarming statistics

Why is a review of policy and legislation necessary? The stats speak loudly!

Papua New Guinea faces formidable challenges.

The country’s systems  need to adjust from to cater for a  population  that has more than  quadrupled over 40 years from 2 million in the 1970s  to more than  10 million people in 2003. By 2030, the projected population will be close to 13 million.

The NDOH’s 2020 figures show that more than 300,000  babies were born in that year.  More than one  million children were under five-years-old and  there there 2.2 million women of reproductive age.

There is a burgeoning  youth population on one end of the spectrum and a growing aging population on the other. There is high  mortality and morbidity from non-communicable diseases.  Along with bigger incomes and easier access to sugar, cheap food and alcohol,  there has been a noticeable rise in obesity, heart attacks and other lifestyle diseases.

Those are just some of the challenges the policy  development team is confronting.

Speaking at the start of this particular  session, Deputy Secretary, Ken Wai, a health professional for over 30 years said  the health department is responsible for a relatively small portion of health.

“We have to think outside of the box.  We tend to think that we can address everything. No.”

The Health Department  can address only 30% of the health challenges while 70% of social economic determinants are outside the scope of the sector. 

They include: Lae and order, access to roads and bridges, access to  education and other government services and business opportunities.

“That’s is why we need the support of the families, tribes, communities, leaders, gatekeepers and the other sectors to help the population to be health conscious and enable the delivery of health services. It is about creating Healthy individuals, healthy families, clans, Healthy tribes, healthy communities and a healthy nation living in a clean, healthy environment.

“That’s why we got to make sure when we are developing policies and legislations,  include that  so it will guide us.”

Taking Responsibility for Personal Health

Empowering individuals to take responsibility for their own health is a pivotal aspect of public health.

Many Papua New Guineans still do not  recognize that  their own actions and choices directly impact their well-being and the overall health of their communities.

For instance, in 2009 when the first cholera outbreak in 50 years was reported in Papua New Guinea, experts identified causes of the disease that could have been prevented  if people practiced and promoted basic hygiene in communities.

By prioritizing preventive measures, adhering to healthy lifestyles, and seeking timely healthcare, individuals can contribute to a collective effort towards healthier communities.

Education plays a critical role in promoting health consciousness. By raising awareness about healthy habits, disease prevention, and the importance of sanitation, individuals can make informed decisions that positively impact their health. Health promotion campaigns, community engagement initiatives, and widespread dissemination of health-related information can ensure that every citizen has access to vital knowledge.

But efforts like this do not always need money.  It needs common sense – a lot of it.

Another obvious example… As the health system is burdened by cases of mouth cancer, people should ask if the cultural practice of chewing buai should continue? Or should be be gradually discouraged over time through a concerned public health effort?

Community participation is vital in shaping a health-conscious society. Encouraging community-driven initiatives, such as the village health assistance program, ensures that healthcare is integrated into the fabric of daily life. By empowering health ambassadors and providing them with the necessary training, communities can cultivate healthier living environments and become advocates for change.