Comments

Thanks for the three sets of comments. I'll only dwell on the ones I disagree with. Don, I'll start with your last comment. I don't think that looking for a sustainable funding mechanism is the place to start. The health sector will remain under-funded for many years: it's not just the revenue collapse, it is that PNG prioritizes other expenditure more highly, especially MP funds. The aid program should be asking what it can usefully do in this difficult context. I would welcome any examples of successful Australian government health capacity building. We reviewed the evidence in our 2010 PNG aid review. The quote from an ODE report we used then is telling: "Expenditure of $150 to $200 million on TA has not produced a step improvement in performance or capacity." Finally, PNG is a resource dependent economy. It is going to be subject to busts and booms. These are difficult to manage, but you can't look to the extractive industry to help solve them for you. (By the way, the Kina needs to fall a lot more.) John, for all your defence of the aid program, you yourself admit that now is not the right time to hand over responsibilities to the PNG government, given the financial crisis. Australian aid can and does change its priorities, but I would like to see effective aid. As I keep saying, in a difficult environment, when you find something that works, build on it. If the aid program has a new and better model, let them share it with the rest of us. Garth, I can't see what strategic need is served by discontinuing successful programs, especially when discontinuation means probable failure. Failure is in no-one's interests. I'm glad the post has generated some discussion, and look forward to more. Stephen

Stephen your article and Don's reply highlight for me the problems caused when the Australian government fails to put the on the ground needs of the poor in PNG first and instead focuses on meeting Australia's strategic needs through the aid program. Regardless of what the Australian government would like in terms of trade, economic development and PNG governance, the reality as both of you point out is that vulnerable people continue to suffer at the present time. The Australian aid program to PNG (and many other countries) is seriously failing these people and also failing the people of Australia who, as surveys tell us, overwhelmingly believe that our aid should be helping the poor and vulnerable. Our aid program needs greater predictability, reliability and funding, more transparency, and a committed and long-term concentration on meeting the needs of the poor. It needs less ideology, fewer fashionable ideas and less national self-interest.

Thanks Stephen For putting into perspective health care funding in PNG with Australian Aid over the past years and current while some facts are: Facts. 1. We understand PNG has poor basic health indicators, less funded by government and resulted in poor health service delivery not only to the remote sites of the country but urban clinics as well. Facts. 2. Donor funding picked up most of the pressing health issues like HIV & TB which the government cannot adequately address quickly but needs sufficient time to strategically address. Facts. 3. Australian has been supporting PNG health programs across a broad range of areas through; grants, direct service delivery, TA placements, through contractors, co-funding, institutional and system strengthening, etc. Facts. 4. PNG government continuous to decrease its actual funding into the health sector than what its budget speaks annually, the free health care policy has no material impact in terms of actual funding. Facts. 5. Australia Aid funding has specific priorities and interests in health issues of PNG rather than a general funding support to PNG and subject to changes where it sees fit Facts. 6. Health issues in PNG is supposed to be PNG government responsibility and changes in Australian Aid is at the discretion of Australian government, it should not be seen as an integral budget component for PNG government. The recent decision by Australian Aid to reduce and eventually re-prioritise health funding, especially to HIV response in PNG is a timely call. Maybe it’s not done at the right time when PNG is faced with financial crisis, but the timing is appropriate after many discussions was held on the future of Australian Aid to PNG and in particular the support to health sector. Many discussions were held with those NGOs affected over the last 3-2 years. The TA placement under the Aid program into PNG departments and agencies has ended last year so this change in the health funding is not a surprise to anyone in PNG and Australia. The Australian Aid program will come up with a new model to support the PNG health sector which among others will include strategic priorities of Australia like concern for regional health security, getting value for money and success that can be replicated elsewhere with a focus on sustainability, while the level of funding remains the same, decrease or increase as long as PNG remains a strategic partner to Australia in the Pacific Region.

yes time is going out very quickly to work together with India specially for producing fly ask brick which will save Bangladesh as well as will contribute significantly to India for maintaining natural environment. ultimately,

Congratulations on raising the issues of health care funding in PNG. The country is facing a major crisis in healthcare funding, illustrated by the plight of NGO's providing care for people with HIV. Imagine the implications if health care funding by government in Australia were to drop 30% in one year. It would damage the entire sector, and not just a specific , though important, disease. It is a mistake to assume that the HIV issues are more important than say maternal health, child health, or immunization,or NCDs. HIV is different as its response is largely donor funded, and it has a high political profile internationally. Many other parts of the sector are in equal if not more distress. It is a systemic problem, not one related to a specific disease or a group of NGOs. The roots of this crisis lie in historic underfunding of the PNG health sector. For most of the last 20 years, the per capita spend on health has been less than the minimum level required to achieve global health goals such as the MDGs - which PNG unsurprisingly failed to reach, as it never had a level of resourcing and capacity that made it possible. To suggest there is "little to show for the decades of effort and millions of dollars that the Australian aid program has invested in capacity building in PNG" is problematic. The response needs to be far more nuanced - building on success applies as much to Aid Programs as recipients. There is ample evidence of effective, and ineffective Australian health capacity building. Furthermore, Australian Government Aid has been a minority funder of health in PNG for years, the bulk of the resource comes from the PNG government. As noted above, the chronic underfunding has led to huge capacity deficits such as a shortage of 20,000 health workers). The lack of impact of capacity building efforts is because of their size as much as their effectiveness. You have previously documented the rise and fall of both the Kina and the government revenue and how "surprised" everyone was that this had happened. There has been very little commentary on how the oil and gas revenues extracted from the country have managed to be maintained during the global low prices , targets met and exceeded, while the full impact has been borne by the PNG government with drastically reduced government revenue and its ability to spend on social services such as health and education. It would seem timely to explore how the benefits and risks of these developments have been shared between government and the extractive industry, particularly when times are tough. Your comments about aid predictability apply equally to revenue predictability in terms of its impact on the wider health sector. Health in PNG desperately needs a sustainable funding mechanism, that gives it a chance of meeting the health SDG. That will need to be a combination of government and donor funding.

Am so pleased to read about what you are doing in terms of dealing with gender based violence. Am a female nurse in Western Highlands Provincial hospital as a Family support center clinical supervisor.We are also dealing with this issue and we are treating ,providing counselling and doing referral of survivors of GBV . Every day we are receiving survivors of physical and sexual violence.Every day ,every where ,there is violence taking place whether its in a home,workplace or in town.Our female staff sometimes get sick leave and miss work because of intimate partner violence especially physical assault which affects our work roster for providing three shifts in a day.The statistics that we have at the center are the reported cases but the unreported cases we don't know. There fore ,its a big issue in the country and I agree that our Government has put a lot of effort in making laws and policies to address and reduce violence in the country.

We're not arguing against removing the requirement of registration under the SWP. I'm not sure it is sensible to say that all employers who hire backpackers should be registered. But at a minimum, labour-hire companies should all be licensed, regardless of whom they hire.

Hi Tara / Grant I'd love to get a copy of your follow up visit (in June this year) after your data analysis later in the year is over and when you publish the research report. I have a cousin brother who is a standards officer for the Baimuru sub-district (Primary School) and he does a wonderful job, but lacks resources to move around. Another cousin sister is a nursing officer in one of the functioning sub health centres. Thank you,

Tara & Grant Thank you so much for making the 2nd trip back to Gulf Province. Yes, I know the feeling when teachers express gut wrenching times/situations they experience in making sure they try their best in implementing the policies of the Government, especially in Education & Health. Over my 6 years (2011 - 2016) in working in the province as a Oil & Gas employee (exploration), I have come across many similar situations described here. My company I work has been as part of its CSR Policies, assisted many remote schools and health centres. I once donated a pretty expensive Solar vaccine Fridge (K30,000.00) to a remote health centre after I assisted a nearby health centre nursing staff manage a measles outbreak in a number of villages near the exploration drilling site. And I have helped deliver school materials where the Govt was not able to. Gulf Province by all means is not remote. It is one of only two provinces in this country that is connected to the Capital City by road, hence it should be taking advantage of this unique position. Yet it is not doing so. It is far cheaper to move things in bulk to Kerema the provincial capital by road from Port Moresby and then re-distributing by Sea, River and Air. The major issue is the proper use of funding to ensure this happens. Unfortunately, most often this is not the case. Contributing issues of good governance are also major concerns when development priorities are mis-placed by leaders (at the political & administrative level). This is also exacerbated by lack of proper planning by key bureaucrats & total negligence by political leaders to lead changes. The end result is lack of development all areas of the development in the province. Gulf has the people at the provincial, district and local level to bring about changes in the people's lives in the key social indexes but need to have good leadership at all levels of the society (Province). Thank you,

Thanks for your response Robin. I certainly agree the GCF is only one avenue of climate finance support and the $100 billion everyone is looking for needs to come from many sources including the private sector, bilateral and multilateral donors. But the implied suggestion that Pacific can look elsewhere for climate funds generates several issues worth considering. Two issues that I find particularly compelling are: 1. The global community doesn't really want more climate funds. You will recall a few years ago that many donors were criticised for their 'proliferation of funds'. The criticism's storyline was that there were too many special interest or regional funds were creating inefficiency for recipients. Perhaps to some extent that is why we ended up with one humongous global fund - the GCF. I don't think this issue has gone away and for the foreseeable future there will be little appetite for setting up a 'Pacific Climate Fund'. 2. The GCF offers a development opportunity that donors can rarely provide: direct access to climate funds. And provides them with a kind of self-determination they find very attractive. My discussions with Pacific leaders lead me to believe it is not just about the money, it is to some extent about independence. I agree that the GCF's 'one fund for all' approach is very ambitious. But the alternative 'one fund for some' is - at the moment at least - even less appealing.

Hi Stephen, I agree that making them less onerous will be beneficial. I disagree that removing the requirement that they be registered is one of the more sensible options. If Australian government agencies including Fair Work Australia have limited resources, it is preferable that they know which employers they need to monitor by way of a registration process rather than trying to monitor everyone which creates the risk of widespread abuse as seen with the backpacker experience.

In an ideal world , superannuation collected from seasonal workers acts as a compulsory savings scheme uplifting the amount of cash that can be repatriated. The reality is that the process of getting it back is cumbersome and if workers do not receive assistance from an employer or agent it is often foregone. A better option is to facilitate payments into the national provident funds in home countries to assist with developing a buffer against financial shocks.