Leadership, governance, and accountability are essential components of the World Health Organization’s core health system framework. They are crucial for improving the system’s efficiency and functionality, ensuring people have better access to health services.
Leadership and governance support other parts of the health system, such as financing, workforce, medicines, medical technologies, information, services, and infrastructure. They involve coordinating all levels of the health system for efficient management and improved performance.
Despite past efforts by Papua New Guinea’s governments to strengthen health systems, significant challenges persist in governance, leadership, and accountability at the subnational level, especially within the Provincial Health Authorities (PHAs). One major issue is the funding of rural health services.
A recent survey on tuberculosis (TB) infection prevention and control policy implementation in PNG’s Highlands and Momase regions revealed that while 80% of district hospitals had plans in place, no specific budget was allocated for their execution. Health workers, facility managers, and district health managers reported a lack of funds for community awareness and health education programs focused on TB.
Health workers explained that funding for rural health services is distributed by the national government through PHAs, making it subject to PHA leadership approval. Our research indicated that poor governance, leadership, and management at the PHA level were to blame for the funding shortfalls affecting healthcare delivery in rural areas. Conversely, effective funding at the district level was linked to strong leadership, governance, and accountability within PHAs.
Accountability is vital in leadership, fostering teamwork and coordinated efforts toward shared goals, such as managing TB effectively. Our study underscored the importance of strong leader-worker relationships in healthcare facilities for achieving better service delivery. When leaders are accountable, employees trust them more, leading to improved performance. Accountability also encourages innovation among healthcare workers, enhancing TB infection prevention and control outcomes in the long run.
Our study’s most significant finding was that district healthcare institutions could not implement TB infection prevention and control programs. Various factors, including long-term healthcare worker shortages, lack of medical technologies and drugs, inadequate funding, and poor infrastructure, limit institutional capacities. Building and maintaining healthcare institutions require determined leadership, management support, and long-term investments to implement key public health policies.
Conversations with community members and patients confirmed that community outreach programs have suffered from funding and resource constraints over the past decades. District hospitals, responsible for primary healthcare in rural areas, lack the necessary resources to provide these essential services effectively.
TB is a complex public health issue. Strengthening partnerships between PNG health authorities and other actors, including development partners, non-government organizations, and Christian Health Services, is critical for the long-term implementation of TB infection prevention and control policies in PNG.
In conclusion, the persistent lack of healthcare funding in PNG’s rural areas is troubling, with PHA leadership, governance, and accountability being significant contributors to the problem. This issue poses a major obstacle to effective TB control policy implementation. A collaborative effort by all relevant actors is essential to support PNG’s TB control objectives.
