Health system strengthening in Papua New Guinea: exploring the role of demand-responsive mechanisms

Challenges facing the health system in Papua New Guinea result not just from low expenditure; this paper argues that performance is also constrained by its structure and by cultural factors, and recommends trialling a new approach. If expectations for improved health outcomes, heightened by the bounty of resource development, are to be achieved without substantial wasting of additional investment, policy makers and program implementers need to consider all potentially viable options. Lessons can be drawn from countries facing similar challenges where the policy mix was broadened to include both supply-side strategies and ‘demand-responsive’ mechanisms (voucher schemes, micro-health insurance, social businesses and social franchises). In Papua New Guinea, these mechanisms could usefully complement existing and emerging policy instruments, including public private partnerships, as part of a more effective overall system of health service delivery. Trialling demand-responsive mechanisms alongside traditional supply-side strategies has the potential to reshape key elements of Papua New Guinea’s health system, redressing structural weaknesses and reducing inconsistencies with cultural realities.