Fee or free? Trading equity for quality of care for primary health care in Papua New Guinea

Fee charging is common at primary health facilities in Papua New Guinea (PNG) and is poorly regulated. To understand the extent of user fees and their implications on access and service delivery, structured interviews with staff and users at 44 primary health facilities were conducted across seven provinces of PNG. Facilities were stratified by management (government or non-government) and accessibility (easy or difficult) and were then randomly selected. Staff at 37 (84%) of the 44 facilities reported charging user fees for at least some goods and services both at church- and government-run facilities. Twenty-one percent of all exit survey respondents said user fees had prevented them attending a health facility on at least one occasion. Almost one-third of facilities were in contradiction of national health policies, charging for deliveries and domestic violence injuries. Moreover, 33 of the 37 facilities charging user fees reported that revenue raised was used to cover operational costs of running health facilities meant to be funded by other sources. Whilst fee revenue reportedly provided valuable additional funding to increase capacity for service delivery, fees caused a barrier to access for some and exemptions were inconsistently applied, often in contradiction with national health policy

User charges for rural health services in Papua New Guinea

This paper reports on a review of user charges for health services in rural areas of Papua New Guinea. Facilities implementing both fee for service and community risk sharing schemes were studied. This study found that there is a lack of any policy framework or practical guidelines on cost recovery. In some areas fees are being used as a fiscal tool rather than to further health policy. This study from Papua New Guinea raises serious questions about the virtue of cost recovery for health services in rural areas. Equity is an issue and the fees are creating a barrier both for entry and continuation in the health system; accountability is poor, and issues of cross subsidization are not addressed; fee revenues from rural health services are small and primarily of local significance; and are not being used to improve quality of health services. Cost recovery schemes in rural areas have the potential to provide a valuable contributory source of income to operate and improve health services. In practice, few are achieving this. It is concluded that health sector financing focus could be more fruitfully directed to financing mechanisms with greater potential to improve and expand health services.Papua New Guinea user charges health financing