National Report - Department Of Health- PNG
National Department of Health2019 Sector PerformanceAnnual ReviewAssessment of Sector Performance2015 - 2019National ReportAugust 2020
Table of ContentsForewordList of IndicatorsReporting Rates SummarySummaryiiiiiivvIndicator 1: Pneumonia - Case Fatality Rate in Children under 5yrs at health facilitiesIndicator 2: Childhood Malnutrition in children under 5 yrsIndicator 3: Low Birth WeightIndicator 4: Malaria Incidence per 1000 populationIndicator 5: HIV confirmed prevalence in pregnancyIndicator 6: Diarrhoeal Disease in children 5 yearsIndicator 7: Injury presentations per 1000 populationIndicator 8: Outreach Clinics Undertaken per 1000 children 5 yearsIndicator 9a: Measles Vaccine Coverage for children under 1yrIndicator 9b: 3rd Dose TA/Pentavalent Coverage for Children under 1yrIndicator 10a: Proportion of Supervised Births at Health FacilitiesIndicator 11: Antenatal CoverageIndicator 12: Family Planning UseIndicator 13: % of children treated with appropriate anti malarial drugsIndicator 14: % of children sleeping under long lasting insecticide-treated net (LLIN)Indicator 15: HIV positive mothers who receive ARTIndicator 16: Case Notification Rate for tuberculosisIndicator 17: Treatment success rate for tuberculosisIndicator 18: Proportion of allocated provincial-level health funds that are spentIndicator 19: Provincial health expenditure as a proportion of estimated needIndicator 20: Supervisory Visits by district and provincial staffIndicator 21: Outpatient visit per person per yearIndicator 22: Proportion (%) of Aid Posts openIndicator 23: Proportion of outbreaks/urgent events identified and assessed within 48 hoursIndicator 24: Total Budget Allocation (HSIP and GoPNG) per capitaIndicator 25: Proportion (%) health facilities that have running water to delivery roomIndicator 26: Proportion of Health Facilities with Telephone and/or RadioIndicator 27: Adequacy of Medical SuppliesIndicator 28: Proportion of Specialist Medical Officers Available in hospitalsIndicator 29: Number of health workers per 10,000 population (stratified by 6272829AppendicesOverall PerformanceProvincial ImprovementProvincial RankingDistrict Performance Score Card 2019AppendixAppendixAppendixAppendixiTable of Contents1234
NATIONAL HEALTH PLAN 2011-20202019 SECTOR PERFORMANCE ANNUAL REVIEWFOREWORDThe Sector Performance Annual Report (SPAR) is a monitoring surveillance tool that enables us tomeasure our progress as a sector on a yearly basis and compare trends for the last five years. It enablesus to know how we are progressing against set targets and the National Health Plan. The SPAR shouldserve as the basis for a proper and careful analysis strictly adhering to the Monitoring & Evaluation(M&E) plan to give us a true picture of our health outcomes. M&E surveillance is mandatory in anyprogram activity and must be given the highest priority in terms of resource allocation. M&E must bean integral part of informed policy, resource allocation, and intervention strategy decision making inthe health sector to achieve improved health outcomes.The 2019 SPAR shows some positive health outcomes in health system reforms of Provincial HealthAuthorities (PHAs), and major public health programs including nutrition, family planning and childhealth. Our challenge is to sustain these successes and improve in areas of poor performance.I appeal to our national, provincial and district health sector service providers and implementersincluding non-government organization and church agencies to take ownership of this report. We allneed to provide strong leadership and good governance and contribute the best we can. Let uscontinue to be accountable for our actions and be innovative in our endeavors to strengthen healthservice delivery for improved health outcomes.I would also like to commend all who have spent time to compile this report. May we continue tofurther refine and adjust our SPAR report so that all development partners, stakeholders andimplementers in the health sector are made aware of the many efforts that they have put to achieve abetter and healthier Papua New Guinea.Finally, I endorse this SPAR report for reference and program evaluation purposes and as a documentfor public consumption.ii
NATIONAL HEALTH PLAN 2011-20202019 SECTOR PERFORMANCE ANNUAL REVIEWIndicator List Sector Performance Annual ReviewInd #IndicatorSourceOutcome1Case fatality rate (in health facilities) for pneumonia in children 5yrsNHISOutcome2Proportion (%) of underweight children under five yearsNHISOutcome3Underweight ( 2500 gm) births as a proportion (%) of total birthsNHISOutcome4Incidence of malaria per 1000 populationNHISOutcome5Proportion (%) of pregnant 15 – 24 year old women who test HIV positiveHIV ProgramOutcome6Incidence of diarrhoeal disease per 1000 in children under 5 yearsNHISOutcome7Total injury discharges from health centres and hospitals for every 1000 popnNHISOutput8Ratio of rural outreach service held to children under 5 yearsNHISOutput9aNHISOutput9bProportion (%) of children at one year of age who are immunised against Measles rubella(MR1)Proportion (%) of children at one year of age who are immunised with 3 doses PentavalentvaccineOutput10Proportion (%) of births attended by skilled personnel at health facilitiesNHISOutput10bProportion (%) of total provincial hospital births that are referred from rural centresunavailableOutput11Proportion (%) of pregnant women who attended at least one ANC visitNHISOutput12Family Planning: couple years protection per thousand women of reproductive ageNHISOutput13PNGIMROutput14Proportion (%) of children under 5 years with fever who are treated with appropriate antimalarial drugsProportion (%) of children 5yrs sleeping under Long Lasting Insecticide-treated Net (LLIN)Output15Proportion (%) of HIV positive mothers who receive ART to reduce the risk of MTCTHIV ProgramOutput16Case notification rate for all TB casesTB ProgramOutput17TB treatment success rateTB ProgramProcess18Process19Proportion (%) of government (functional grants) and development partner contributions that NEFCare expended.Provincial health expenditure (government and development partner contributions) as aNEFCproportion (%) of estimated minimum health expenditure required.Process20Proportion (%) of health centres that have received at least one supervisory support visit from NIHFdistrict or provincial management staff during yearProcess21Average number of outpatient visits to hospitals and health centres per person per yearNHISProcess22Proportion (%) of Aid Posts openNHISProcess23ProgramInput24Proportion (%) of outbreaks identified and assessed by NDoH within 48 hoursTotal budget allocation (HSIP and GoPNG) per capitaInput25Proportion (%) of health facilities that have running water to delivery room.NHIFInput26Proportion (%) of health centres/hospitals with functioning radio/telephone/mobile.NIHFInput27Percentage of months that facilities do not have stock-outs of all selected medical supplies for NHISmore than a week in the month.Input28Input29NHISPNGIMRPLLSMANHSS ProgramProportion (%) of general hospitals which have at least 3 of the 5 key specialtiesNumber of health workers per 10,000 population (stratified by cadre)iiiHR BranchList of Indicators
NATIONAL HEALTH PLAN 2011-20202019 SECTOR PERFORMANCE ANNUAL REVIEWReporting RatesNational Health Information System Reporting Rates 2015-2019ProvinceWesternGulfCentralNCDMilne porting rates Summary
NATIONAL HEALTH PLAN 2011-20202018 SECTOR PERFORMANCE ANNUAL REVIEWSummary CommentsThis report provides a snap shot of health sector performance by province for 2019 and compares results over the last 5years. Analyses of indicators show that health sector "inputs" declined by 0.24% and indicators of "outputs" also declined(2.55%) between 2015 and 2019). Over the same period, indicators of outcomes also declined (6.59%). The performance ofthe sector in the last 5 years has declined by 2.8%.Programmes with positive changes are seen in nutrition interventions (for child malnutrition); a decrease in case fatality ratesfor children under five years admitted with pneumonia; and the prevention and control of diarrhoeal disease amongstchildren under the age of 5 years. There is continuing work in policy areas, including amongst others, review of the NHP 20112020, heath workforce, further development of Community Health Posts and District Hospitals, full adoption of ProvincialHealth Authorities, some important work in budget and finance (for example, Facility Based Budgeting, and ongoing reform ofthe medical supply system.Of concern, is that there continues to be a decline in the number of outreach clinics, with subsequent lower vaccinationcoverage and antenatal attendance. This leads directly to vulnerability of children (in nutrition monitoring and protectionagainst vaccine preventable disease) and fewer opportunities to safeguard the health of mothers and their unborn child.Supervised births are also noted to decline with decreasing antenatal care. There has been patchy improvement in thecoverage of family planning programs, thought to be attributable to the further introduction of Long Acting RemovableContraceptives. All districts need to have these opportunities available.In the Disease Control Program areas, we observe further increasing incidence in malaria. HIV infection prevails, with too fewof those infected on treatment over the past four years, the disturbing high rate of Mother to Child Transmission. TBincidence rate has remained stagnant over the past five years. However, TB case notification has increased over the pastthree years and treatment success rate increased from 68% in 2018 to 76% in 2019.Provincial Performances and ImprovementsThe five best performing provinces in 2019 are NCD, Chimbu, Western Highlands, Milne Bay and New Ireland. Conversely,Gulf, East Sepik, Southern Highlands, Madang and East Sepik are identified as poor performing provinces. However, if allprovinces were at the same level of development NCD, Milne Bay, New Ireland, Manus and Morobe would be the bestperforming provinces using the constraints index (See Appendix 2). The purpose of using this index is to level the playing fieldwhen making comparisons of performance between provinces. It suggests that these provinces do comparatively well whenone considers the relative hardships they face.The most improved provinces in 2019 are Madang, Jiwaka, Hela, Western Highlands and Central while West New Britain,Milne Bay, Western, ARoB and East Sepik are the least improved provinces.Technical Comments Population data: In late 2018 the NDoH adopted a revised set of population estimates, derived from the 2011 census. The methodologyused in developing the estimates was approved for use by the Department of National Planning & Monitoring. Theserevised populations were projected over the time period 2011 to 2022. All indicators that use a population denominatorhave been recalculated for all years covered in this report that is 2015 to 2019. The revisions of the populations wasundertaken to address inconsistencies and perceived errors identified by the provinces. The review of the population dataconfirmed a number of these perceptions. The revision of the populations expects to show a more accurate performance.However, for some indicators and some provinces, the indicator values appearing in this report may be significantlydifferent from that previously published. The calculation formula in the family planning indicator based on Couple Years Protection (CYP) has beenupdated to use the current international standard for protection for each type of contraceptive. The simple under-reporting correction used in previous SPARs has been continued. This is a facility levelcorrection where the correction factor of x (12 / number of forms actually received) is applied to each facilityyearly total value.viSummary
NATIONAL HEALTH PLAN 2011-20202018 SECTOR PERFORMANCE ANNUAL REVIEW Reporting year: The data analysed in this report relates to the full 2019 calendar year data (January to December), ratherthan over a split year as previously was the case. For all indicators with population denominators these have beenrecalculated over the relevant calendar years. Data corrections: As earlier year’s data were being reanalysed a few obvious data errors were noted and these have beencorrected. Indicator 2: This indicator reports the proportion of underweight children who have been weighed at MCH clinics, basedon the Weight for Age percentiles. A revised NHIS monthly form was introduced in 2019 and this changed the WFAcategorising from percentiles to Z-scores. The filling out this form is confusion for many health facility OICs due to lack oftraining and advocacy, thus calculations for 2019 are done using data collected from the old forms completed in 2019. Facility based indicators: For the three facility based indicators; availability of communications, water in delivery roomand proportion of aid posts open have combined data from 2018 to ensure adequate completeness. That is, for facilitieswhere there was no data for 2019 but there was data for 2019, this 2019 data was used. Data was not available for indicator 10b (Referral rates for hospital delivery) due to lack of consistent approach torecording data in NHIS;Transition to the eNHISNDoH is transitioning to the use of the new eNHIS system for data collection and analysis. The Tablet based data collection isalready working fully in 8 provinces with the PC based reporting and analysis software being used in all provincial offices andthe NDoH office. All NHIS data has been migrated to the eNHIS and data for this SPAR analysis was extracted from thatsystem.Further actionsPerformance monitoring requires information on program inputs, implementation and results. Despite limited analysis, thisreport should be used by managers and health workers to review their data and how performance can be improved to bettermeet community need.eNHIS is available in the provinces and to programs to be used at any time when needed. Information should be used at thepoint of collection before it is compiled for analysis at the national level. Hence, data should be used at health facilities, at thedistrict and provincial levels before being sent to NDoH.Your comments, criticisms and suggestions will improve the value of the SPAR and create demand for information.Any queries or comments on the report should be directed to the Performance Monitoring and Research Branch of NationalDepartment of Health: Ms Manah Dindi: Ph: 3013650; Email: manah.dindi2@gmail.com.viSummary
NATIONAL HEALTH PLAN 2011-20202019 SECTOR PERFORMANCE ANNUAL REVIEWIndicator 1: Percentage of Pneumonia Deaths in Children under 5yrs at Health FacilitiesDefinition: The percentage of children under five years of age that are admitted tothe health centre with pneumonia and die during that admission% pneumonia deaths in 5 yrs admitted to health facilities, 4%1.5%1.9%2.1%WESTERNGULFCENTRALNCDMILNE T SEPIKWEST SEPIKMANUSNEW IRELANDENBPWNBPARoBNGI2.6%NATIONAL2.3%Source: National Health Information System1.2%.Page 8% Pneumonia Deaths in children 5 years, ERNNGI20182019HIGHLANDSIndicator: Measures the in facility case fatality rate for childrenunder 5 yrs who are admitted for treatment of pneumonia anddie during that admission. Pneumonia case fatality rate has beenshown to be a sensitive indicator of quality of care in numerousenvironments, although other factors may affect mortality (forexample, late presentation, malnutrition), it is expected thatavailability of antibiotics, health worker training and theintroduction of oxygen should impact upon case fatality. To thisend, it provides a good indication of the quality of servicecoverage.Performance: Overall there has been a general decline in casefatality rate over the five-year period, 2.3% to 2.1%. But given thelarge year to year variations in individual provincial results thisshould be treated with caution and may well not be statisticallysignificant. The Annual Paediatric Mortality and Morbidity report2019 (data from 20 hospitals) also shows improved casemanagement of children with pneumonia.
NATIONAL HEALTH PLAN 2011-20202019 SECTOR PERFORMANCE ANNUAL REVIEWIndicator 2: % children moderately or severely underweightDefinition: Percentage of children under five years who attend Maternal and Child Healthclinics that are moderately (60 –80% Weight for Age) or severely ( 60% weight for age)underweight.Percentage of children weighed at clinics 80% weight for age% Children under five yrs 80% expectedweight for age, 35%9%9%8%9%9%30%MILNE 35%30%28%26%26%EAST SEPIK28%26%26%31%36%WEST SEPIK33%33%37%35%34%MANUS15%17%15%15%24%NEW 1%20%21%NCDREGIONSource: National Health Information SystemNA: Data not availablePage GI20182019HIGHLANDSIndicator: Measures percentage of children under 5 years of age,who have attended and been weighed at MCH clinic, andweighed less than 80% of the standard weight for age.Performance: The national underweight rate has steadilydeclined among children aged under five years old who hadattended MCH clinics across PNG from 2015 to 2019.Regionally, the rates of Momase still remained higher while otherregions have shown slow decline. The rates from the provincesshow East Sepik, West Sepik and Gulf reported the highest ratesin 2019 while Chimbu and NCD reported the lowest.
NATIONAL HEALTH PLAN 2011-20202019 SECTOR PERFORMANCE ANNUAL REVIEWIndicator 3 - % Low Birth Weight BabiesDefinition: The percentage of live births in facilities that weigh less than 2500gramPercentage of facility births less than 2500 gm, ILNE T SEPIKWEST SEPIKMANUSNEW IRELANDENBPWNBPHIGHLANDSMOMASENGINATIONALSource: National Health Information SystemPage 10% Babies born at health facilities weighing lessthan 2500g, NMOMASENGI2019HIGHLANDSIndicator: Measures the proportion of those children that areborn in health centres and hospitals and weigh less than 2500gPerformance: The national percentage of facility births with lowbirth weights appears to be stable between 2015-2019, whileregionally the proportion of babies born with less than 2500gvaried considerably from 2015 to 2019. LBW is a significantcontributor to the high levels of neonatal mortality in PNG,therefore comprehensive antenatal care is important to addressthis concern. Management of LBW babies requires acomprehensive approach, including the promotion of KangarooMother Care (skin-to-skin contact).
NATIONAL HEALTH PLAN 2011-20202019 SECTOR PERFORMANCE ANNUAL REVIEWIndicator 4: Malaria Incidence per 1000 populationDefinition: The rate of confirmed cases of malaria (confirmed by slide or RDT) andprobable (Unconfirmed) cases of malaria (cases that were not tested, but treatedas malaria) per 1000 head of populationMalaria cases per 1000 population, 2015-2019PROVINCEMalaria cases per 1000 D5146423840400MILNE HERNEAST SEPIK122121117175131MOMASENGIWEST SEPIK292290360344419MANUS158207162252231NEW ATIONALSource: National Health Information SystemPage 1115010050020152016201720182019HIGHLANDSIndicator: The incidence rate of confirmed cases of malaria(confirmed by slide or RDT) and probable (Unconfirmed –clinically diagnosed) cases of malaria per 1000 populationPerformance: The incidence of malaria increased between 2015and 2018 from 97 to 118 then declined in 2019. The incidence inmost areas of the Highlands region remains low, although somedistricts are seeing greater burden of Malaria. The risingincidence of malaria over the past three years is a cause for greatconcern. This increase has been validated by prevalence studies.The low rates in the ARoB are anomalous in relation to the muchhigher and rising incidence rates in the other NGIs.
NATIONAL HEALTH PLAN 2011-20202019 SECTOR PERFORMANCE ANNUAL REVIEWIndicator 5: HIV confirmed prevalence in pregnancySurveillance antenatal clinic PMGH 2010 - 2019HIV Prevalence among ANC mothersPMGH antenatal clinic, 2010-2019Confirm positive HIV confTotal testsHIV %1.26%1.24%0.78%0.94%1.00%0.50%0.00%Data source: PMGH Division of O&G Annual Report, 2019Performance: HIV prevalence among pregnant women 15-24 yearsNB: The PMGH ANC data is the most important data for the HIV estimatesand projections exercise because of its long consistencies in keeping goodrecords.had varied over the last 10-year period with the highest numberof confirmed HIV cases reported in 2010. It declined from 1.74%to 0.78% between 2011 and 2012. Since 2012 there has been afairly steady rise in incidence up to approximately 1.80 in 2018and 2019. Surveillance Surveys (SSS) Antenatal surveillanceamong younger antenates (15-24 years) provides an indication oftransmission among a more sexually active cohort. The HIVprevalence amongst this group has increased between 2014 and2019.PMGH 2019Antenatal Clinictotal testedPMGH labour ward2195total conf. Positive3914581.8%634.3%(b) HIV serosurveillance at Antenatal clinics in PNG among 15 - 24 year olds15- 19 yr oldYearscreenedconf. Pos20 - 24 yr old% Posscreenedconf. PosTotal 15 - 24% posscreened% 5480.93%Page 12
NATIONAL HEALTH PLAN 2011-20202019 SECTOR PERFORMANCE ANNUAL REVIEWIndicator 6 - Incidence of Diarrhoeal Diseases in children 5 yearsDefinition: The incidence of diarrhoeal disease in children under 5 years per 1000children under 5 years.Diarrhoeal Diseases in 5 years (cases/1000 NCD589521401376350MILNE 9115EAST SEPIK8589818882WEST SEPIK365167167188169MANUS267181112142114NEW 5207182REGIONIncidence of diarrhoeal disease inchildren 5 years, OUTHERNMOMASENGI2019HIGHLANDS113Source: National Health Information SystemPage 13Indicator: Number of children less than 5 years old withoutpatient presentation to health centre or hospital withdiarrhoea per 1000 children under 5. Environmental influenceson well-being include access to clean water, appropriate disposalof faeces and access to hygienic supplies of foods provide thebasis to avoidance of diarrhoeal disease. Food hygiene has beenan increasing concern with greater transportation and aproliferation of food outlets in an environment where regulationis mostly not enforced.Performance: Overall there has been a decrease in incidence atnational level over the past five years, though with markedvariations between provinces and years. The very high ratesnoted in some highlands provinces such as Hela and Enga is atleast partially attributable to the anomalous low under 5population estimates for these provinces in the revisedpopulation estimates being currently used. Diarrhoeal incidencein Manus, West Sepik and Oro dropped by more than 50% since2015.
NATIONAL HEALTH PLAN 2011-20202019 SECTOR PERFORMANCE ANNUAL REVIEWIndicator 7: Injury presentationsDefinition: Total presentation of injuries to health centre and hospital outpatient for every1000 populationInjuries reported at outpatients/1000 person, 2015-2019PROVINCEPresentations /1000 populationOutpatient injury presentations per 1000population, GULF4450263344CENTRAL2019212222NCD4639394441MILNE MOROBE2621222329MADANG2523202125EAST SEPIK2119202123WEST SEPIK4032354646MANUS5367625456NEW GIONNGI41NATIONAL34Source: National Health Information SystemPage 14302010020152016201720182019HIGHLANDSIndicator: Total presentation of injuries to health centre andhospital outpatient for every 1000 populationAll injury is consolidated into one category although particularaspects of injury may be of inerest to analyze programintervention (e.g. transport related injury, domestic violenceetc).Performance: Outpatient injuries reported have remainedconsistent from 2015 to 2019 with figures from the Southern andNGI regions being comparably higher than the other regions andthe national figures. New Ireland, Milne Bay, Manus, WesternEast New Britain provinces reported high injury rates during this5-year period suggesting a need to investigate what types ofinjuries the patients present with and the causes of these injuriesin these low-violence coastal areas.These data differ from those captured through Verbal Autopsystudies, where higher prevalence is seen in several otherprovinces. More work is required to understand the causes andpattern of Injury in PNG to develop evidence-based preventionmeasures to consistently reduce the injury rates.
NATIONAL HEALTH PLAN 2011-20202019 SECTOR PERFORMANCE ANNUAL REVIEWIndicator 8 - Outreach Clinics per 1000 children 5 yearsDefinition: Ratio of outreach clinics held to 1000 population under 5 yearsOutreach clinics held for every 1,000 children 5 F10119103CENTRAL343139373922321MILNE DANG1616151618EAST SEPIK17105810WEST SEPIK2222232134MANUS7510112411873NEW NAL3428283131REGIONSource: National Health Information SystemPage 15Total outreach clinics held/1000 children 5 yrs, MOMASENGI20182019HIGHLANDSIndicator: The indicator calculates the ratio of outreach clinics (ofall types) held per 1000 children under 5 years age. Outreachclinics provide a key platform for preventive child healthprograms and an opportunity for individual community healtheducation. Previous assessments have demonstrated thecorrelation between rural outreach and immunisation coverage.The conduct of outreach clinics also provides an indication of thecapacity of the health system to provide service provisionobligations – identifying planning, finance, supply and humanresource gaps and barriers.Performance: There has been only slight decline in con
This report provides a snap shot of health sector performance by province for 2019 and compares results over the last 5 years. Analyses of indicators show that health sector "inputs" declined by 0.24% and indicators of "outputs" also declined (2.55%) between 2015 and 2019). Over the s
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