The development of basic health services in Papua New Guinea, with particular reference to the Southern Highlands Province
The process of underdevelopment in Papua New Guinea is bringing rapid change for the mass of people as more areas are incorporated into the export oriented cash economy, with disruption of social and economic formations, growing inequality and deepening dependency. This is despite national objectives emphasising more equal development based on the needs of the rural majority. Health services have grown within the framework of underdevelopment and are characterised by an imported clinical model, hospital bias and inequality. The 1974-1978 health plan attempted, unsuccessfully, to reverse trends to urban, curative services and to develop basic rural services using the aid post system in particular. Aid post provision began after the second world war but has, until recently, suffered from relative neglect. Attempts to plan more effectively, and recent decentralisation, may provide the basis for the development of services following a primary health care approach. However, redistribution of resources to the rural majority remains problematic. The Southern Highlands province ranks lowest on most health indicators; as in the majority of rural areas morbidity and mortality patterns indicate the need for primary health care. The distribution and utilisation of health services within the province reflect the national situation, with emphasis on hospital and health centre treatment. Provincial objectives include spatial redistribution of health facilities to improve access and the pursuit of primary health care, focussed on aid posts. Among a number of problems found with aid posts, the orientation and attitudes of orderlies may be inimical to the community development approach of primary health care. The massive, externally-funded, economic development project in the province epitomises the dilemmas of change in the country. For health, as for so much in contemporary Papua New Guinea, the question is whether change will bring development or the extension of underdevelopment.