A Partnership Model for Improving Service Delivery in Remote Papua New Guinea: A Mixed Methods Evaluation.

Emma Field,Dominica Abo,Alex Rosewell,Louis Samiak,Mafu Vila,Sally Nathan,Georgina Dove

doi:10.15171/ijhpm.2018.50

Abstract

Background: The Community Mine Continuation Agreement Middle (CMCA) and South Fly Health Program (the Health Program) is a partnership for improving health service delivery in remote Papua New Guinea (PNG). The Health Program is delivered by a private contractor working in partnership with existing health service providers to improve service delivery using existing government systems, where possible, and aligns with national policies, plans and strategies. A midline evaluation was conducted to determine changes in health service delivery since commencement of the Health Program. Methods: A mixed methods evaluation was undertaken mid-way through implementation of the Health Program, including a pre/post analysis of health service delivery indicators, semi-structured interviews with health workers and assessment of health facility equipment and infrastructure. Results: Improvements in many of the long-term expected outcomes of the Health Program were observed when compared to the pre-program period. The number of outpatient visits per person per year and number of outreach clinics per 1000 children under 5 years increased by 15% and 189% respectively (P<.001). Increases in vaccination coverage for infants aged <1 year were observed: 58 % for pentavalent 1st dose (P<.001) and 75% for 1st dose Sabin (P<.001), 30% for 3rd dose pentavalent (P<.001) and 26% for measles vaccination (P<.001). Family planning coverage remained at similar levels (increasing 5%, P=.095) and antenatal care coverage increased by 26% (P<.001). Supervised deliveries coverage declined by 32% (P<.001), a continuation of the pre-Program trend. The proportion of facilities with standard equipment items, transport and lighting increased. Health worker training, in particular obstetric training, was most commonly cited by health workers as leading to improved services. Conclusion: Following implementation, substantial improvements in health service delivery indicators were observed in the Health Program area as compared with pre-program period and the stagnating or declining national performance. This model could be considered for similar contexts where existing health service providers require external assistance to provide basic health services to the community

Highlights

This study describes a partnership in remote Papua New Guinea (PNG) where a private contractor works with existing government and faith-based health service providers to improve service delivery
The Health Program was delivered through a partnership, where a private contractor worked with existing health service providers to improve service delivery using existing government systems, where possible, and aligned activities with national policies, plans and strategies
Health Service Delivery There were substantial increases in outpatient visits, child attendances, outreach clinics, vaccination and antenatal care in the Program period compared to the pre-Program period (Table 2)

Summary

Introduction

One model for improving service delivery involves engaging the support of non-government or private providers to deliver defined health services.[1,2,3,4,5] This contracting-out model of public-private engagement for service delivery can fill capacity gaps within governments and has been used in developing countries including Afghanistan, Ghana, Malawi, and Pakistan.[6,7,8,9,10] The documented benefits from this model include improvement in the utilisation, coverage and quality of health services and more effective human resource management and procurement.[6,7,8,10] negative outcomes associated with this model include: no improvement in quality of health services; ineffective referral; poor integration with national health programs; by-passing government process eg, for drug procurement; and concerns for sustainability.[8,10] Evidence for the effectiveness of such models for improving health service delivery is limited, partly due to the challenge of rigorously evaluating complex service delivery programs as opposed to evaluating single interventions or packages of interventions.[11].

Methods

Results

Discussion

Conclusion