Interview: Dr Amyna Sultan
What benefits can private services bring to the health sector in Papua New Guinea?
DR AMYNA SULTAN: It is important that the benefits derived from private-sector involvement stay within the country, in the form of both physical assets and skills transfer. To this end, public-private partnerships where the state builds the infrastructure while the private sector contributes capital and human resources represent a sustainable model for the future of the industry, as the government struggles to cope with growing demand for technology to improve health care delivery.
Private health institutions are able to provide services that were previously unavailable in PNG. In the past, people had to fly abroad at a very high cost, and it is not uncommon to hear of people having to raise large sums of money for cardiac surgery, MRIs, neurosurgery or retina surgery. Now, we can provide these treatments locally at a fraction of the cost. The redesigning and refurbishing of existing public hospital facilities is an expensive exercise in PNG. It will take years to revamp these hospitals, since most of them have been long neglected. As far as I can see, there is a growing demand for private tertiary health care in PNG.
What sorts of synergy may arise between public and private institutions in health care delivery in PNG?
SULTAN: The government could outsource tertiary services unavailable in public hospitals to private ones. There could be sharing of facilities and technology required for interventional cardiology, cardiac-thoracic surgery, MRIs, neurosurgery or radiation oncology. These services can be set up by private investors even at public hospitals, as has been done successfully in more mature markets like Australia and the US. This would allow public-referral patients to receive preferential tariffs that would reduce costs substantially.
Ideally, the government would outsource services and then subsidise private providers to offer treatments that public centres currently do not offer, thus widening the choice of services. Building, for example, a new cardiac centre from scratch at a public hospital where even basic facilities are still being revived would be a very expensive exercise. Clearly, it would be more economical to involve the private sector.
Private involvement can provide cutting-edge technology and facilitate knowledge transfer through a pool of international doctors who could help build capacity in PNG. Plenty of funds have been directed to the health sector in this country; yet the shortcomings are not always about money, but about capacity, management and efficiency. Doctors from both the public and private sectors are starting to believe in the possible synergies, and we are confident it will not be long before such engagement occurs in PNG.
Which segments of the population could afford private hospitals given PNG’s low-income status and need for primary health care?
SULTAN: Only a small portion of the population –those in the higher socio-economic strata and employed citizens with health insurance – will benefit from institutions like Pacific International Hospital if the state does not ensure that subsidies are given to private partners to reach out to every citizen who needs, say, heart surgery. We are already reaching out to plenty of Papua New Guineans who in the past could not afford to fly overseas for treatment but now can afford surgery in PNG. The introduction of new, state-of-the-art hospitals with cutting-edge technology will also help raise the bar for health care in PNG and encourage public hospitals to achieve the same standard.
We are very supportive of the government’s efforts to introduce universal health care, but for it to be effective, the infrastructure must first be in place. The principle in the new legislation that each province will take responsibility for its own health care, from primary care all the way up to tertiary referral hospitals, seems the right way forward. Only devolution will ensure that funds are spent correctly, in line with the specific needs of each institution within the provincial health plan.
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