Bougainville's Health Services - Past and Present
Patrick Nomos | 24/2/2020
At the time of Papua New Guinea's (PNG) independence in 1975, health services in Bougainville were provided as part of the PNG National Health System, with very strong support from the mainstream churches. In my mother's village on Buka Island, the local health centre was managed and staffed by church workers and lay volunteers. Public hospitals were based at the major centres of Arawa and Buka.
One of the initiatives of the Bougainville Copper Foundation (BCF), established in 1971, was the North Solomons Medical Foundation (NSMF) that was set up at Arawa in 1979 to provide an alternative to the Arawa Public Hospital. The NSMF's clinic and small hospital were initially funded by the BCF but it was intended that their running costs would be covered by fees. Despite the imposition of a fee for service, the NSMF became a very popular facility.[1]
During the Crisis
In May 1990 the PNG Government began to cut off services to Bougainville in what was to become known as the "blockade". Virtually no manufactured goods, including medicines, reached Bougainville, triggering a collapse in the economy, causing many deaths and forcing Bougainvilleans to return to a traditional way of life. The blockade remained in position until the ceasefire in September 1994 and operated informally for much of Bougainville until 1997.[2] In 1992 the Arawa Public Hospital was burned down by the Bougainville Revolutionary Army (BRA) followed by the NSMF in 1995.
During the Crisis, often the only medical service on Bougainville was run by the Papua New Guinea Defence Force (PNGDF) and the only surgeon was a PNGDF officer. The peace-keeping forces also provided medical servicesi.[3]
The international medical-humanitarian organisation Médecins Sans Frontieres (MSF) began working in Bougainville in 1992, but because of the Crisis withdrew after an intervention of approximately six months. MSF returned to Bougainville in 2011 to support primary and maternal-child healthcare at the Buin District Health Centre.
In early 1997 the PNG Red Cross and International Federation of the Red Cross mounted an international humanitarian relief programme that delivered over 130,000 family packs of relief goods in BRA and PNG Government-controlled areas. These packs contained medicines, clothing, utensils and tools.
Although a comprehensive death toll attributable to the Crisis is unavailable, most organisations quote a figure between 10,000-20,000, and in 2005 the United Nations News Centre estimated the death toll at 15,000. Most deaths arose from lack of health care rather than occurring outright in battle, with preventable diseases such as malaria, and high rates of maternal and child mortality being major contributors.
Post-Crisis
Post-conflict reconstruction and restoration of health services has been slow. Dr Cyril Imako, Executive Director of Health Services in Central Bougainville, says that the maternal mortality rate (MMR) is believed to be about 690 per 100,000 live births, three times higher than PNG's estimated MMR. A high MMR is an indication of very poor, and possibly worsening, maternal health. Child mortality rates are very high and health centres regularly run out of basic medicines.[4]
In 1998 the Australian Government-funded Buka General Hospital (BGH) was opened in Buka town, becoming the provincial hospital and main referral centre for Bougainville. Prior to its opening the Buka Public Hospital and dispensary were situated on Sohano Island at the western end of Buka Passage, posing logistical problems with sea transport of patients to and from Bougainville and Buka Islands.
The BGH operates as part of the PNG National Health System, whereas village health centres and sub-health centres throughout Bougainville are administered by the Bougainville Division of Health, with support from mainstream churches and volunteer organisations. The BGH provides the following clinical services: Out-Patient/Accident and Emergency Department, and units for Surgery, Obstetrics and Gynaecology, Paediatrics, Medicine, Anaesthesia, Dentistry and Psychiatry. Diagnostic services include medical imaging and a laboratory. Support services include a pharmacy, blood transfusion service, operating theatre and a Family Support Centre.
From 2015-2018 the Australian Government provided PGK33.8 million for the upgrading of the then Arawa Health Centre to become the Arawa District Hospital (ADH). The upgrading was delivered through the PNG-Australia Partnership with the Autonomous Bougainville Government's (ABG) Department of Health. Since the upgraded hospital opened to the public in 2017, the delivery of health services has doubled its daily operational attendance, admissions, antenatal care and deliveries.
Arawa has a private town clinic, located near the ADH, that provides medicines to address the ADH's chronic medicine shortages. There is one private doctor practising in Buka, formerly employed at the BGH, with a modestly-equipped clinic located in Buka town. At Buin there are no private doctors, so the first line of medical services is provided by the Buin District Health Centre (BDHC), a 38-bed facility that refers to the ADH and BGH depending on clinical assessments .
New Zealand's Volunteer Service Abroad (VSA) began working in Bougainville in 1998, focusing on reconstruction efforts and responding to immediate post-conflict needs. Some of its volunteers have worked to address the critical shortage of nurses by supporting the re-opened Arawa School of Nursing, and working alongside staff at the ADH and BDHC.
While many health centres provide excellent services in the face of shortages of funding, and qualified staff and medical equipment, their management is vulnerable to corruption. In rural communities with smaller health centres, allegations have been made about nursing staff selling prescription medicines to supplement their incomes, health centre board members embezzling aid funding provided for the construction of health centre staff housing and ambulance drivers misusing ambulance vehicles as privately-operated taxis. Oversight of Bougainville's health services needs to be strengthened so that scarce resources are put to their optimum use.
Post- Referendum
Despite the optimism generated in Bougainville by the December 2019 announcement of the overwhelming referendum vote in favour of independence from PNG, the outlook for Bougainville's health services in the near to medium-term is not encouraging. While human development indicators are difficult to obtain for Bougainville, the most recent annual provincial review of health services across PNG shows that Bougainville has two hospitals, 11 health centres, and 24 sub-health centres, with a health-worker to population ratio of 0.4 to 1000. In comparison, Vanuatu's health-worker to population ratio is around 1.73 to 1000.
Bougainville's expenditure on health represents approximately one per cent of its annual budget. Vanuatu's expenditure is 3.5 per cent of a much larger budget, while Solomon Islands allocates 8 per cent of its budget to health, a budget which is 10 times larger than that of Bougainville. [5]
While government and non-government agencies continue to provide Bougainville with financial and manpower assistance to support its struggling health system, the task of maintaining, staffing, and stocking hospitals and village health centres with medical supplies is immense. At a time when PNG is seemingly incapable of adequately operating its own national health system, it doesn't appear likely that the ABG will soon be able to deliver a comparatively effective level of health services to its long-suffering people.
Photo: Buka General Hospital