Papua New Guinea
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Enhancing public health: A journey of renewal in Papua New Guinea

BY SCOTT WAIDE

In a small conference room at the headquarters of the Department of Health (DOH) in Port Moresby, a group of Papua New Guinean public health experts resume the mentally grueling 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 legislation and the absence of that much needed guiding policy complicated efforts.

As the emergency progressed, the government found it necessary to pass a new law – the National Pandemic Act of 2020.

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.

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 Department of Health.

The work being done now complements ongoing policy and legislative reforms that the DOH 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 10million people in 2003. By 2030, the projected population will be close to 13 million.

The DOH’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 are 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 20 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.
Health is everybody’s business. The Health Department can address only 30 per cent of the health problems but social determinants of health account for 70 per cent of the health challenges.

“That 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 recognise 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 prioritising 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.