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  • Title: Quality of health services in Papua New Guinea: what do we know?
    Author: Thomason JA.
    Journal: P N G Med J; 1993 Jun; 36(2):90-8. PubMed ID: 8154201.
    Abstract:
    The discussion of quality issues in Papua New Guinea requires that attention be focused on what is known about the actual quality of the health care provided in Papua New Guinea. Since 1987 there has been increasing evidence that there are serious deficits in the quality of care in rural areas and that there are similar problems in the country's hospitals. This paper summarizes what is known and discusses the implications for the development of quality assurance activities in Papua New Guinea. The paper concludes that many of the deficiencies observed are amenable to improvement through simple and inexpensive means and that with sustained commitment, improvements are achievable. Evidence has recently surfaced in Papua New Guinea that, in the process of expansion of the delivery of health services, there are serious deficits in the quality of rural health care. Improvements are attainable through simple and inexpensive means; the only obstacle is lack of commitment by relevant national and provincial government authorities. There are two prominent studies of interest: 1) a 1988 nationwide survey of quality or rural health services at health centers and subcenters, with by 26 focus groups of community concerns (staff absences, lack of commitment in provision of services, poor and unsympathetic treatment, and referral and death); and 2) a nationwide study of costs of hospital services in 1989. Immunization is dependent on the stock of vaccines, an operational clinics. Obstetric emergencies can be handled only if there is a delivery area, oxytocic drugs available, and suction or other instruments. Treatment of febrile convulsions depends upon a ready supply of quinine, chloramphenicol, and paraldehyde, a clean, well-lit treatment area for performing a lumbar puncture, and a standard treatment manual for gauging proper drug dosage. The first study findings showed that 37% of ward buildings were in need of maintenance and 13% were unsanitary. Only 36% of health centers had running water inside the building year-round. New patients at 24% of health facilities were seen primarily by orderlies or nurses aides. Only 31% had a night duty attendant. 19% did not have oxytocic drugs. 40% of child clinics did not have refrigeration, and only 51% had sufficient vaccines. 29% did not have clinical supervision. 45% could not handle obstetric emergencies. Factors influencing quality were size of center, religious affiliation, and supervision present. Regional variations existed; for instance, there were higher quality centers at island church centers and government health centers in the highlands. Findings from 13 government hospitals showed inadequate management, inadequate support to primary health services, lack of facilities and equipment, and drug shortages. Training and management were considered crucial to improved quality.
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