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

Document Type : Original Article


1 Global and Tropical Health, Menzies School of Health Research, Brisbane, QLD, Australia

2 Abt Associates, Brisbane, Australia

3 School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia

4 Abt Associates, Port Moresby, Papua New Guinea

5 University of Papua New Guinea, Port Moresby, Papua New Guinea


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.

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.

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 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.

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.


Main Subjects

  1. Thomason J, Kase P, Ndugwa N. Working together to get back to basics--finding health system solutions. P N G Med J. 2009;52(3-4):114-129.
  2. Thomason J, Rodney A. Public-private partnerships for health--what does the evidence say? P N G Med J. 2009;52(3-4):166-178.
  3. International Council on Mining & Metals. Community health programs in the mining and metals industry. https://www.icmm.com/en-gb/publications/mining-partnerships-for-development/community-health-programs-in-the-mining-and-metals-industry.  Accessed October 20, 2017. Published 2013.
  4. Barr DA. Ethics in public health research: a research protocol to evaluate the effectiveness of public-private partnerships as a means to improve health and welfare systems worldwide. Am J Public Health. 2007;97(1):19-25. doi:10.2105/ajph.2005.075614
  5. Whyle EB, Olivier J. Models of public-private engagement for health services delivery and financing in Southern Africa: a systematic review. Health Policy Plan. 2016;31(10):1515-1529. doi:10.1093/heapol/czw075
  6. Hushie M. Public-non-governmental organisation partnerships for health: an exploratory study with case studies from recent Ghanaian experience. BMC Public Health. 2016;16:963. doi:10.1186/s12889-016-3636-2
  7. Newbrander W, Ickx P, Feroz F, Stanekzai H. Afghanistan's Basic Package of Health Services: Its development and effects on rebuilding the health system. Global Public Health. 2014;9(sup1):S6-S28. doi:10.1080/17441692.2014.916735
  8. Chirwa ML, Kazanga I, Faedo G, Thomas S. Promoting universal financial protection: contracting faith-based health facilities to expand access--lessons learned from Malawi. Health Res Policy Syst. 2013;11:27. doi:10.1186/1478-4505-11-27
  9. Ejaz I, Shaikh BT, Rizvi N. NGOs and government partnership for health systems strengthening: a qualitative study presenting viewpoints of government, NGOs and donors in Pakistan. BMC Health Serv Res. 2011;11:122. doi:10.1186/1472-6963-11-122
  10. Ravindran TK. Privatisation in reproductive health services in Pakistan: three case studies. Reprod Health Matters. 2010;18(36):13-24. doi:10.1016/s0968-8080(10)36536-0
  11. Peters DH, El-Saharty S, Siadat B, Janovsky K, Vujicic M. Improving Service Delivery in Developing Countries: From Evidence to Action. Washington, DC: The World Bank; 2009.
  12. National Department of Health. 2015 Sector Performance Annual Review: Assessment of Sector Performance 2011-2015 National Report. 2016. http://www.health.gov.pg/publications/SPAR_2015.pdf.  Accessed October 20, 2017.
  13. Howes S, Mako AA, Swan A, Walton G, Webster T, Wiltshire C. A lost decade? Service Delivery and Reforms in Papua New Guinea 2002-2012. http://devpolicy.org/publications/reports/PEPE/PEPE_A_lost_decade_FULL_REPORT.pdf.  Accessed October 20, 2017. Published 2014.
  14. Government of Papua New Guinea. National Health Plan 2011-2020: Volume 1 Policies and Strategies 2010. http://www.health.gov.pg/publications/PNGNHP%20Vol1_2014.pdf.  Accessed October 19, 2017.
  15. Roehrich JK, Lewis MA, George G. Are public-private partnerships a healthy option? A systematic literature review. Soc Sci Med. 2014;113:110-119. doi:10.1016/j.socscimed.2014.03.037
  16. Public-Private Partnerships for Public Health. Reich MR, editor. United States of America: Harvard Center for Population and Development Studies; 2002. https://cdn1.sph.harvard.edu/wp-content/uploads/sites/480/2012/09/Partnerships_book.pdf. Accessed May 29, 2018.
  17. The National Council for Public-Private Partnerships: 7 Keys to Success.  https://www.ncppp.org/ppp-basics/7-keys/.  Accessed March 19, 2018.
  18. CMCA Middle and South Fly Health Program. http://www.cmsfhp.org/about-us/.   Accessed January 2, 2016. Published 2013.
  19. National Statistical Office Papua New Guinea. National Population & housing Census 2011 Final Figures Papua New Guinea. 2013. http://www.nso.gov.pg/index.php/document-library. Accessed October 19, 2017. Published 2013.
  20. National Department of Health. 2012 Sector Performance Annual Review: Assessment of Sector Performance 2008-2012 National Report. http://www.health.gov.pg/publications/SPAR_2013.pdf.  Accessed October 19, 2017. Published 2013.
  21. JTA International. Mid-Term Review of the North Fly Health Services Development Program. Published 2012.
  22. Abt JTA. Kiunga Hospital Annual Report 2013. http://www.nfhsdp.org/wp-content/uploads/2014/10/For-upload-Kiunga-Hospital-Annual-Report-2013.pdf.   Accessed October 19, 2017. Published 2013.
  23. Abt JTA. 2013 Annual Report North Fly Health Services Development Program 2014. http://www.nfhsdp.org/wp-content/uploads/2013/11/NFHSDP-Annual-Report-2013-23092014.pdf.  Accessed October 19, 2017.
  24. Government of Papua New Guinea. National Health Service Standards for Papua New Guinea 2011-2020: Volume 1.  Published 2011.
  25. JTA International. Feasibility Studies for the Middle and South Fly Health Development Program. Published 2012.
  26. JTA International. North Fly District Health Services Baseline Study. Published 2009.
  27. Papua New Guinea Health Sector Monitoring and Evaluation Strategic Plan: National Health Plan (2011-2020). National Department of Health; 2012.
  28. Abt JTA. CMCA Health Middle and South Fly Health Program: Baseline Survey Report. Published 2013.
  29. CMCA Middle and South Fly Health Program: Map of key program indicators.  http://www.cmsfhp.org/health-facilities/key-indicators/.  Accessed February 4, 2017.
  30. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77-101.
  31. Miles K, Conlon M, Stinshoff J, Hutton R. Public-private partnerships in the response to HIV: experience from the resource industry in Papua New Guinea. Rural Remote Health. 2014;14(3):2868.
  32. Rispel LC, Peltzer K, Nkomo N, Molomo B. Evaluating an HIV and AIDS Community Training Partnership Program in five diamond mining communities in South Africa. Eval Program Plann. 2010;33(4):394-402. doi:10.1016/j.evalprogplan.2010.02.001
  33. Swana EK, Makan GY, Mukeng CK, et al. Feasibility and implementation of community-based malaria case management with integrated vector control in the Democratic Republic of Congo. Malar J. 2016;15(1):413. doi:10.1186/s12936-016-1475-3
  34. Callan M. More about the development contributions of mining and petroleum companies in PNG. DevPolicy Blog. 2013. http://devpolicy.org/more-about-the-development-contributions-of-mining-and-petroleum-companies-in-png-20130716/.  Accessed 20 October 20, 2017.
  35. Maraga S, Namosha E, Gouda H, Vallely L, Rare L, Phuanukoonnon S. Sociodemographic factors associated with maternal health care utilization in Wosera, East Sepik Province, Papua New Guinea. P N G Med J. 2011;54(3-4):154-163.
  36. Ok Tedi Mining Limited. Ok tedi Mining Limited - Health Services.  http://www.oktedi.com/our-corporate-social-responsibility/health-services. Accessed September 28, 2016.
  37. Toikilik S, Tuges G, Lagani J, et al. Are hard-to-reach populations being reached with immunization services? Findings from the 2005 Papua New Guinea national immunization coverage survey. Vaccine. 2010;28(29):4673-4679. doi:10.1016/j.vaccine.2010.04.063
  38. Barlow J, Roehrich J, Wright S. Europe sees mixed results from public-private partnerships for building and managing health care facilities and services. Health Aff (Millwood). 2013;32(1):146-154. doi:10.1377/hlthaff.2011.1223
  39. Barlow J, Roehrich JK, Wright S. De facto privatization or a renewed role for the EU? Paying for Europe's healthcare infrastructure in a recession. Journal of the Royal Society of Medicine. 2010;103(2):51-55. doi:10.1258/jrsm.2009.090296
  40. Cadwell ND, Roehrich JK, George G. Social Value Creation and Relational Coordination in Public‐Private Collaborations. Journal of Management Studies. 2017;54(6):906-928. doi:10.1111/joms.12268
  41. Kivleniece I, Quelin BV. Creating and capturing value in public-private ties: A private actor's perspective. Academy of Management Review. 2011;37(2):272-299. doi:10.5465/amr.2011.0004
  42. Ashwell HE, Barclay L. Problems measuring community health status at a local level: Papua New Guinea's health information system. Rural Remote Health. 2010;10(4):1539.
  43. Vogus A, Graff K. PEPFAR Transitions to Country Ownership: Review of Past Donor Transitions and Application of Lessons Learned to the Eastern Caribbean. Glob Health Sci Pract. 2015;3(2):274-286. doi:10.9745/ghsp-d-14-00227