Distribution and performance of rural health workers in Papua New Guinea.

As part of a study of the costs of rural health services in Papua New Guinea, an examination was made of the distribution and performance of rural health staff. The cost study and the use of a staffing model which related the staffing of health facilities to their workload both yielded valuable new data about the cost, distribution and productivity of rural health staff. Key findings of the workforce study included an inequitable distribution of staff among facilities, concentration on curative activities, better performance of staff of church run facilities and consequential variations between different categories of health worker in the allocation of work time to priority programmes. These findings are already being used to guide Papua New Guinea's health policy. They have also opened up several new important questions, such as the impact of different categories and mixes of staff on quality of health centre performance.

Aid post and hospital orderlies: a vanishing breed?

A survey of all aid post and hospital orderlies was conducted in 1987 and 1988 to gather information about their sex, age, length of service, public service status, qualifications and work location. Information was collected for an estimated 71% of the total number of orderlies. A fifth of all orderlies--almost all of whom were men--were 55 years of age or over and almost half had served 20 years or more. Substantial provincial differences were evident, with Gulf, Northern and Enga provinces having the oldest orderlies. A quarter of the orderlies were public servants and 16% did not hold a certificate. The majority (70%) worked at the aid post level. health centre orderlies were older, less likely to hold a certificate and more likely to belong to the public service. Using the most conservative estimate, the orderly cadre is estimated to be short by almost 500 workers. The paper argues that considerable gains in both the cost and the quality of services could be achieved by replacing older, untrained orderlies with newly trained community health workers with clear job descriptions.

A survey of Papua New Guinean private medical practitioners.

A postal survey of all Papua New Guinean private medical practitioners was conducted to ascertain their practice characteristics, how well they kept up with current medical knowledge and whether they were interested in contributing to public sector medicine. Replies were received from 44% of the doctors, who mostly represented the younger age group of graduates. The majority of the responders had entered private practice since 1981, were self-employed and made little use of existing opportunities for keeping up to date with medical knowledge. The average number of patients seen in a day showed a normal distribution with a peak at 20-29 patients per day. Over 75% of the responders stated that they would be willing to work for the government health services on a sessional basis at an average minimum hourly rate of K40. Financial reasons were given as the main justification for leaving government service. When asked whether they would return to full-time public service if doctors' terms and conditions improved, the private practitioners were evenly divided. Those interested in returning would expect an average annual salary of approximately K30,000 per annum. In this paper we argue that private medical care has so far been allowed to develop without guidance and controls, and little use has been made of it to support government health services. Escalating shortages of financial and human resources have now made it imperative to find innovative ways of developing both services in harmony with each other so that private medical services for the mostly urban minority will not grow to the detriment of public medical services for the rural majority.