DWU Health Management Department Newsletter

this is a monthly newsletter for Divine Word University’s Health Management Departmenet staff and students

Volume 2 Issue 3 - 4 April - May 2012

Fourth year Health Management stu-dents have finally handed over dra� project proposals to several commu-nity organisa�ons in Madang.

The Health Management students, un-der the HM404 Project Planning and Design unit, have worked with various organisa�ons to develop proposals for community projects. This was a 15 week unit which saw 21 students use the Logical Framework Appraoch to develop eight (8) projects each worth between K42,000 to K200,000.The organisa�ons that the students worked with were:• Lutheran Day Primary School – Latrine Rehabilita�on • Na�onal Disability and Re-source and Advocacy Centre – Screen prin�ng for People With a Disability (PWD)• Save the Children - Increasing access to Sexual Reproduc�ve Health (SRH) Informa�on for young, out of school youths in rural Madang• DWU Student Services – Re-habilita�on of DWU Water Supply• Madang Country Women’s Associa�on - Village Health Volunteer Program • Pendamon United Church – Building a Double Classroom for Chil-dren in Pendamon United Church• Pathfinder Interna�onal - Improving Sexual and Reproduc�ve Health of Divine Word University Stu-dents• DWU Physiotheraphy Clinic – Awareness Program for DWU Physio-theraphy Clinic

The proposals have been developed using the Logical framework Approach (LFA). The LFA is an analy�cal tool for objec�ves-oriented project planning and management. It can be applied in a

wide range of circumstances and to a range of types of aid ac�vity. In the Health Man-agement course, during the final year, the 4th year students work in the Project Plan-ning and Design unit, to iden�fy a health problem and develop a proposal for fund-ing to eradicate the health problem. The students’ proposals took aboud 12 weeks to develop. The proposals were divided into three sec�ons to make it easier to work on during the semester.

Sec�on I• Title and Cover Page• Introduc�on – Overview of Project • Situa�onal Analysis• Problem Analysis • Objec�ve Analysis• Stakeholder Analysis

Sec�on II• Project Design – Logical Frame-work, Ac�vity Descrip�on • Project Budget, Cash Flow Fore-cast, Implementa�on Framework

Sec�on III• Project Execu�on and Implemen-ta�on Framework • O r g a n i s a t i o n a l Framework• Project Risk Man-agement and Risk Strategy • Aligning of Project to Provincial and Na�onal agendas • Monitoring and Evalua�on • Conclusion

Many of these organisa-�ons said that there were problems that had iden�-fied but could not develop project proposals to send to development agencies to fund.

The Unit Lecturer, Mr. Kingston Namun, said that the project proposals were wri�en for these organisa�ons to help them iden�fy and prepare a funding proposal for their projects.He said: “These proposals are one of many efforts carried out by the DWU communty to foster its Community Engagement program and at the same �me equip the students to take part in real life experiences of these organisa-�ons and understand how different or-ganisa�ons work in the Madang Com-munity.“These proposals are s�ll seen as dra�s where the organisa�on can update them and make changes to it and then send to various development agencies to fund.“The students have learnt a lot about iden�fying problems and developing a project to combat these public health problems in Madang Commun�es.“I hope the students who take this unit next year can work with these commu-nity organisa�ons to help them with these type of proposals,” he said.

Fourth Year Health Management Student Mr. John Demok (left) presents the Lutheran Day Laterine Rehabilitation Project Proposal to Mr. Peter Siwi, the Principal of Lu-theran Day Primary School (right)

HM students work with community organisations to develop proposals

Mr. Oreme Tipo,Head of Health

Management Department, in the Faculty of Health

Sciences, Divine Word University

Article by Thesar Titus

INTRODUCTIONProfessional Health Ethics is the system rules of moral behavioral standard governing personal behavior practices by healthcare professionals from all levels of health facili-ties (Medical society of PNG, 2008). Ethics are kind of like morals or common sense as well as being ‘ethical’ means trying to be reasonable and do what you think is right. Health ethics is not enforced by the government as a law to govern health professional behavior, but it’s like rules of conduct that should be practiced in all health sectors (William, 1991). Dis-cussed below are health ethical behavior practices by health executives from management level down to the clinical staff.

MANAGEMENT PERSPECTIVEPotential Ethical Challenges are constantly faced by Health Service Managers. Most of the blame are put on the clinical professionals regarding practices of health ethics towards the patients (Samei 2012). But the problem lies at the manage-ment level, that Health Managers are to promote, model and reward ethical behavior as well as discipline unethical conduct for all health executives in health industries. Why must Health Care Managers manage with respect and integrity to adhere ethical practices? Simply because failure to do so will result in, corrupt practices at the work place, health staffs and patients dissatisfaction as well as lose of re-spect and dignity for one another (Samei 2012). They should have professional code of ethics that will guide their work behavior and relationship with all members of health care organisation.Healthcare managers do not directly deal with patients but are responsible in making ethical decisions and implement-ing strategies that will create an ethical environment for every health executive for better ethical behavior practices. These include establishing responsible parties such as ethics

committees to seek and ensure that ethical behavior is practiced by each individual in the organisation. They must also provide ethics training to their health officers so they can improve their professional ethical behavior practices.

CLINICAL PERSPEC-TIVEThe primary responsi-bility of the clinical staff such as nurses and doctors are to provide quality care and change to the people. Their moral professional obligation is to ensure safe and adequate treatment and care are given. It seems that many of the clinical workers are considered to be lacking in health ethics and this encourages them to discrimi-nate their patients at times (Samei 2012). This unethical behavior practices could also tarnish their professional integrity in the workplace and violate a patient’s right to access basic health care services.Every human being regardless of their place of origin, race, cul-ture, gender, politics, social position or beliefs has a right to access basic health services provided by Health Care Organisation (Nurs-ing Council of Papua New Guinea, 2002). Clinical staff should be equipped with high ethical standards to deliver best treatment with respect for the people’s dignity and not to discriminate over them. Unethical behavior such as ‘wantok system’ is commonly practiced today by health workers, giving the best treatment to their loved ones es-

Health Management training at DWU encompases Professional Ethics and also Christian Ethics - both are essential.

HM Students keep Power of Positive Learning BurningHello everyone, I would like to welcome you all to this edition of the Health Management Newsletter for 2012. Well it has been a tough few months for staff and students of this department. In April we said good-bye to the former HOD, Ms. Maragreth Samei as she left to run the Tabubil Hospital in Western Prov-ince. I take this time to thank her for her tireless efforts and down to earth approach to improving and bringing this department to where it is now. The students in this course have greatly benefited from her experience and public health management knowledge over the past three years she spent here. Thank you!We recently had the DWU Open Day in which the department and its partners took part in. I saw many students on the Open Day give their best and I am sure the Madang public who came to our stalls learnt more about Health Management and its importance in the PNG Health Care System. I would like to thank the Chairperson, Ms Jessica Wape, your committee and the Year 3 students in leading this years’ Open Day preparations and activities on the day. Thank you! Well, the first semester has flown by so fast and the second semester is just about to begin. I honestly know that we all in this department will keep the theme for this year ‘Power of Positive Vision’ alive and moving forward as a community. There are so many things, some which you will see in this news-letter and many others happening as I speak. Please read through this newsletter and get a feel of what is happening in this department - it is positive and encouraging. We are training health managers to be proactive, critical thinkers, competent managers, ethical and abiding by the chrisitan principles in-grained into the subjects we teach here in DWU so I hope this is evident in the stories that you read in this newsletter. I know 2012 is turning out to be a wonderful year for HM staff and students at DWU. God Bless You all and I hope you receive good information in this newsletter. HAPPY READING....

......Continued on page 4

PRACTICING PROFESSIONAL HEALTH ETHICS BY HEALTH EXECUTIVES IN PAPUA NEW GUINEA

Dealing carefully and respec�ully with people who come across your path helps you develop professional leadership abil-ity and be�er people management skills

Potential Ethical Challenges for Health Service Managers in PNG

By Ms Margareth Samei, MBE. Lecturer for Professional Health Ethics in Health Management

Introduction Significant challenges facing healthcare organisations such as financial pressures, rising public and consumers expectations, health reforms, patient safety and quality improvement issues, have placed healthcare organisations under great stress—thus potentially intensifying ethical questions and issues. The Challenge lies with Health Ser-vices Managers to manage with integrity and consistently adhere to professional and ethical standards.

Potential Ethical Challenges Health Services Managers in the Government and Church run health Care Organizations in PNG are constantly faced with ethical challenges when making resource manage-ment decisions as they too have personal challenges (fam-ily obligations). They are expected to manage principles of organization ethics (Trevino, Butterfield, and McCabe 1998) which upholds what the organization stands for. Below are common examples of challenges faced by health managers and service organizations in PNG.- Wantok System- Compensation- Corruption

Wantok System“Wantok system” in the PNG context has many meanings and perceptions. One of the common characteristics of Wantok system is giving preference and favor to people we know over others. This expectation under Wantok system is supported by Deontology theory which states that people should abide by their obligations and duties when analys-ing an ethical dilemma. This theory also requires that person will keep to his obligation for another individual or society such as family members or friends because doing so is carrying out his duties and regarded ethical by that society. The expectations and values described above remain with the managers and place him or her on the crossroad. The challenge remains with Health Manager to uphold profes-sional and work ethics over cultural/ clan social relation-ships values and obligations to clients at the workplace. This often creates a conflict of interest when making management decisions by health managers. Clinical prac-titioners such as nurses, doctors, health extension officers and others face the same challenge in their practice.

CompensationThe demand for compensation in monetary value by those afflicted as result of unethical or professional misconduct, medical and administrative negligence in provision of health services, is on the rise in health care organisa-tions/institution. Unethical behavior and conduct at work by health managers and workers increase the risk of liability thus monetary compensation. More and more PNG nationals are educated and are aware of their legal and human right for quality and safe health care. Dissatis-fied clients or patients will initiate court actions against

organisations if they believe that they have unnecessarily suffered due to negligence or unethical action by a health care provider or management. In law such action is called a litigation case. For example successful litigation court by dissatisfied patient will result in payment of compensation of huge amount by the employing health organization. A health care organization with history of litigation cases is evidence of poor ethical work practices and environment.

Corruption Wantok system and greed are rife in public sector demon-strated by poor service delivery and misappropriation of government and development partners’ funds for personal use and unbudgeted activities. Poor work performance, unethical work behavior, unethical management deci-sions, lack of responsibility and non compliance with standard work practices are some evidence of corruption at work places. When health managers fail to comply with public finance management law and guidelines for managing health funds and other resources under their reasponsibility, they lose focus and respect.

Over the last few years and in the next ten years funding allocation for health facilities have increased (National Health Plan 2011-2020). Mismanagement and mis appropriation of health funds is a major risk and health mangers are called to demonstrate accountability and transparency in their work practices. Two consequences of corruption by health manager are• health manager being prosecuted by police or dismissal from work• Patients will suffer unnecessary denial of their legal and human rights to health service.

Other forms of corruption by health workers include steal-ing of drugs from hospital or health centre for personal or family use, coming late to work, absenteeism without good reason, lack of responsibility in proper usage and care of work tools and facilities and not fulfilling days paid work. The challenge lies with Health Services Managers to man-age integrity and consistently adhere to professional and ethical standards.Why must Managers manage integrity and consistently

adhere to professional Ethical Standards? Failure to do so will result in- Corrupt practice at workplace- Low work productivity- Customer dissatisfaction- Loss of Public confidence - Loss of respect Strategies for Creating an Ethical Work Environment.Health Care Organisations have different approaches for creating ethical work environments. Below are convention-al strategies which could be adopted by organizations who are serious about Creating Ethical Work Environments.• Health Service Managers acting with other responsible parties such as ethics committees must foster and support a culture that not only provides high-quality, cost-effective healthcare but seeks to ensure the ethical behavior and practices of all staff.• Recognizing the importance of ethics to the organisation’s mission, healthcare managers must demonstrate the importance of ethics in their own actions and seek various ways to integrate ethical practices and reflection into the organization’s overall culture.• Create an ethical culture for all employees (i.e. staff, whether paid or unpaid, and trainees), healthcare managers should:• Support the development and implementa-tion of employee ethical standards of behavior including ethical clinical, administrative, research and quality improvement practices, and• Ensure that effective and comprehensive ethics resources, including an ethics committee, exist and are available to all employees to develop, propagate and clarify such standards of behavior when there is ethical uncertainty.• The manager also must support and imple-ment a systematic and organisation wide approach to ethics training and corporate compliance for all staff.• The ability of an organisation to achieve its full potential will remain dependent upon the motivation, knowledge, skills, and ethical practices and values of its staff. Thus, the executive has an obligation to accomplish the organisation’s mission in a manner that respects the values of individuals and maximizes their contributions.

ReferenceBeauchamp, T. L., and Bowie, N., E., (2001). Rights and Obligations of Employers and Employees. In Ethical Theory and Busi ness, 6th ed. Englewood Cliffs, NJ: Prentice-Hall. Winkler, E. and Gruen, R., (2005). First principles: Substantive ethics for healthcare organizations. Journal of Healthcare Manage ment. Volume 50, Issue 2, page 09-120. Government of PNG Papua New Guinea, (2010). National Health Plan 2011-2020, Volume 1Polices and Strategies: Trevino, L. K., Butterfield, K.,D., and McCabe, D., L., (1998). The Ethical Context in Organizations: Influences on Employee At titudes and Behaviors : Business Ethics Quarterly,

Volume 8 Issue 3, page 447-76

pecially friends, family and relatives and deny others who experience the same conditions. CONCLUSIONFor the health organisation to be effective and successful, professional health ethics should be practiced by all health executives. Health ethics is not enforced by the government but are the rules of conduct that requires all health professionals to adhere. It should be applied in all circumstances, in the work environ-ment when dealing with patients as well as the health staffs. Health service managers are the key people who must create ethical environment and man-age ethical behavior in the health facilities of PNG. Frequent use of health ethics creates an ethical and friendly environment for patients to access basic health care services with bet-ter satisfaction and expected treatment care. However, ethical behavior practices depend largely on the decision makings of the health authorities.

RECOMMENDATIONSAs health management students, we have learned different levels of health ethics and moral issues that are greatly affecting our health industry. Health professionals are becoming more ig-norant in practicing ethical behavior as it start from the health managers down to the doctors and nurses. Lack of respect among health ex-ecutives and discrimination practices towards the patients is at its highest levels today.You will be graduating from this university, as a challenge, how will you deal with such issues in order to create an ethical and friendly environment in the health organizations? You have done an advance learning of Professional Health Ethics and will be working in health organisation such as hospital, provincial health offices or private health sectors that are domi-nant by unethical behavior practices. The coun-try needs new trained people like you who will stand out and make the difference in the health industry of our country. Therefore, learn as much as you can while here because it is very tough and challenging out there in the field.

Thesar Titus is a 2nd Year Health Management Student this year 2012

REFERENCESMedical society of PNG, (2008). Carving the future Health of PNG. Retrieved from http://www.mspng.org/index.php?option=com_content&v iew=frontpage&Itemid=76Nursing Council of Papua New Guinea (2002). Code of Ethics for Nurses in Papua New Guinea. Retrieved from http://health.legislation. polhncourses.org/index.php?option=com_content&view=article&id= 54:code-of-ethics-for-nurses-in-png&catid=38:papua-new-guinea&Itemid=62 Samei, M., (2012). HM203 Module 5, Creating Ethical Work Environment. Samei (slide presentation)William, B, (1991). Ethics for Medical Health Professionals. Social Science Press, Gogbin Poole.

Article by Tanumeng Bowase People are social beings because every day of our lives, we tend to socialise with each other (Yesharim 2009). There is a saying that goes “no man is an island” fulfills the fact that we are always interacting with each other in one way or other. Therefore, when an individual socialises himself or herself with others, they form what is called a group or a team. Individuals form groups to share common interests, responsibilities and many other roles (Schein, 1980). Divine Word University is made up of different groups called faculties. Under each faculty, there are other sub-groups which are the different departments. For example, under the faculty of Health Sciences we have Health Manage-ment Department (HMD), Rural Health Department (RHD), Environmental Health Department (EHD) and Physiotherapy Department (PYD). Further-more, the departments are then made up of different levels which are classified in years like; HM1, HM2, HM3 and HM4.Therefore, HM 2 for this year 2012 is one of the groups which is made up of individuals and is also a part of the larger group, the Divine Word University. At the beginning, we had a larger group but as time rolled on, the group size decreased because we lost some of our course mates. To lose a group member is a heart ache because in our little ways, each one of us contributes to the team. To be more specific, there were 33 of us in class at the beginning of this year, unfortunately, we lost three of our course mates, Luke Dabre, Shadrick Lanito and Janneslyne Mosena leaving the group with 30 students in class. They left because of some personal reasons but their absence was a loss to the class in many ways. The class is very unfortunate with the absence of Luke Dabre because he was such a guy with an outstanding character. He has been so friendly, out spoken, a leader who willingly takes responsibilities, kind, a brother, a friend and of course our class captain. Likewise, Shadrick Lanito who is also our course mate, a brother, a friend and most important thing that the class will miss from him is that he sometimes makes class alive with some of his questions that he asks in class thereby making the class argue or debate over his points. And not forgetting our sister Janneslyne who also posses some kind of outstand-ing characteristics which some of us admire. Specially, the HM2 girls will miss her a lot because we already have that relation-ship of being as sisters. The message to all of us is, let us not be too ignorant with the friends and people around us. Appreciate their com-panionship because we might regret it when we come to realize that we have lost someone special in our lives. Remember, each and every one of us contributes in one or the other towards the success of the bigger group.

Tanumeng Bowase is a 2nd Year Health Management student

References:Schein. (1980).The functions of groups. Englewood Cliff. Prentice hall.Yesharim M. (2009). Human beings are social beings. Retrieved on 011th/04/12 from: http://fin korswim.com/2009/06/03/human-beings-are-social-beings/

Heartache Moments...

The HM Year One class when they started last year in 2011. They are in second year now.

Continued from page 2

Building Capacity of PNG health training institutions essential to meeting the health needs of the growing PNG population

Article by Megu Tony

There is a chronic shortage of well trained health workers (Cuboin et al., 2010). The shortage is global, but most acutely felt in the countries that need them most. For a variety of reasons, such as the migration, illness or death of health work-ers, countries are unable to educate and sustain the health workforce that would improve people’s chances of survival and well-being. Health workers, are a vital ingredient in the strengthening of health systems but it takes a considerable investment of time and money to train health workers.

In the Pacific region, doctors are generally employed in hospi-tals in urban areas, while nurses deliver the majority of health services in rural areas. For example, more than 50 per cent of all doctors in Papua New Guinea work for the National Depart-

ment of Health (in-cluding urban clinics in the National Capi-tal District), approxi-mately 37 per cent work in hospitals and less than 10 per cent work in the provincial areas, while over half of all nurses work for provincial health ser-vices (Henderson & Tulloch, 2010).

The supply of new health workers from

training institutions in PNG is believed to

be insufficient to meet current and future demand. According to Asaten and Hall (2011) some 11,142 personnel of different categories reportedly worked in the health system in 2009 . This was made up of 333 medical officers, 2,844 nurses and midwives, 3,883 community health workers, 718 allied health workers, 409 health extension officers, 1,821 support staff and 1,134 other cadres of health workers. Approximately 600 nurses, 600 community health workers and 100 midwives are reportedly required to fill the existing gaps (Asaten & Hall, 2011). In Vanuatu, for example, there are simply inadequate resources or training capacity to train and employ the increas-ing numbers of nurses, and others (notably those who require scholarships), required to meet the needs of a growing popula-tion (Connell, 2010). Countries must give higher priority, and greater finance, to the education of health workers, alongside related accommodation, facilities and faculty

Aside from the low numbers of trained personnel there are issues with the quality of health worker training in PNG. Train-ing is also not adequately linked to provincial needs for health workers although the provinces have the autonomy under the Organic Law to determine the number health workers they can afford to hire (IMRG 2008).The PNG Profile (2011) stated that nurse-to-population ratio is estimated at 1:2271 popula-tion. An additional 600 nurses, 600 community health workers and 100 midwives are estimated to be needed to fill vacant posts, but current production rates are insufficient to fill the gaps. Also the doctor-to-population ratio is estimated at 1:19 399 population, the majority of doctors being in Port Moresby. The scarcity and mal-distribution of human resources for health has not been addressed effectively, and there have only been limited and not very coordinated efforts in training and

other approaches to capacity-building. Recommendations from the Human Resources for Health Forum, conducted in 2008, included the urgent need to upscale health care worker train-ing and to develop a human resource development plan (PNG Profile, 2011).

Taking in to account all the above discussions, health work-ers are vital tool to the effective and efficient functioning of the Health System. However, the health worker force in the Western Pacific Region is not improving to cater for the growing popula-tion. The recommended ratio for health workers to the popula-tion by Joint Learning Initiative on Human Resources for Health is not been achieved and PNG is not an exception. As a result, PNG has not achieved its MDGs. The annual output of health workers in PNG by training institu-tions (Universities & Colleges) is insufficient to meet the growing population. This is one of the contributing factors apart form lack of effective planning, limited health budgets, migration of health workers, inadequate numbers of students entering and/or completing professional training, limited employment opportuni-ties, low salaries, poor working conditions, weak support and supervision, and lim-ited opportunities for professional develop-ment. The National Health Department is responsible for train-ing and should collab-oratively partner with respective universi-ties and colleges to address this issue.

Divine Word Uni-versity is one of the institutions in PNG that has produced health workers. Apart from other health train-ing institutions in PNG, the NDOH must concentrate on building DWU Faculty of Health Sciences as a supplementary solution to address the workforce shortage in the country. Building the capacity of DWU Faculty of Health Sciences is a cost effective solution to addressing the nation’s workforce crisis. This is due to the fact that DWU Faculty of Health Sciences produces a skill mixed of qualified accredited health workers who can be able to complement the Health System allowing the nurses, CHWs and Doctors to accomplish their roles, thus improving primary health in the country.

Megu Tony is a 4th Year Health Management student

References:Miles, M. B., & Huberman, A. M. (1994). Qualitative Data Analysis (2nd ed.). California: SAGE Publications Inc.PNG Independent Monitoring and Review Group (Health). (2008). Prioritizing IMRG recom mendations and drafting terms of reference for IMRG 2009 with improved focus and broader representation. PNG Independent Monitoring and Review Group (Health), Report No. 5, Port Moresby.Asante, A & Hall, J. (2011). A review of health leadership and management capacity in Papua New Guinea. Retrieved February 24, 2012, from http://www.med.unsw.edu. au/HRHweb.nsf/resources/LM+PNG+Web.pdf/$file/LM+PNG+Web.pdf.Cuboni, G., Dever, G., Do, H., & Thoulang, J. (20120). Pacific Health Dialog. Human Resources for Public Health Challenges in the Western Pacific – Local Community College Respond, 16(1), 173-180. Retrieved from http://www.pacifichealthdia log.org.fj/volume16_no1/Human%20Resources%20for%20Public%20Health%20C hallenges.pdf.Henderson, L. N. & Tulloch, J. (2010). Human Resources for Health. Incentives for retaining and motivating health workers in Pacific and Asian countries, 6(18), 1-20.doi:10.1186/1478- 449 1 -6-16.Connell, J. (2010). Health Workers Mighration. Migration of Health Worjers in the Asian Pacific Region, 3, 1-32. Retrieved from http://www.hrhhub.unsw.edu.au/HRHweb.nsf/re sources/3_Migration_Web_20100112.pdf/$file/3_Migration_Web_20100112.pdf.

Building the capacity of Health training schools is important to empowering health workers in the country. Picture courtesy of Don Brice/ABM 2003

Health Management students listening to their lecturer, Mr. Albert Sika, during a tutorial

Knowledge of HIV lacking among tertiary students

Article by Joseph Angli

Human Immunodeficiency Virus (HIV) is an infectious agent that causes Acquired Immunodeficiency Syndrome (AIDS), a disease that leaves a person vulnerable to life-threatening infections. Scientists have identified two types of this virus (Abbott et al, 2008). HIV-1 is the primary cause of AIDS worldwide. HIV-2 is found mostly in West Africa. Sex can be seen as an act of reproduction which the ultimate target is to keep the human race from extinction (Kelly et al, 2008). Many would agree with that. It is as old as time itself. However, the way people practise and appreciate sex differs greatly. Sex is often associated to HIV because HIV can be transmitted through sexual acts. AIDS, the disease, was first diagnosed in Papua New Guinea in 1987 (The Na-tional, 2002). Since then, there are total of 30 448 AIDS cases in 2010 as reported by National AIDS Council of PNG (National Department of Health, 2010). The PNG government declared AIDS as an epidemic in 2003 (National Department of Health, 2010) and has tried to combat the HIV/AIDS epidemic ever since. The fight has been a hot topic in the media to promote safe sex and minimise the spread of AIDS. The government working on prevention measures. Our poor people back home and on the streets have high expectations that in-school youths will be the ones educating them about the disease. However, their expectations seem less fruitful as many students in tertiary schools lack the essential and adequate knowledge about HIV and Sex. Some students may not know what the initials HIV and AIDS stand for, or the signs and symptoms of the disease or even its prevention methods and its mode of transmission (Kelly et al, 2008). How often do students discuss about HIV and sex in their daily life? I guess this is not known. At some point in time they may discuss it, may be because an event instigated it, for instance, someone they know had acquired the disease, or it is a discussion in class. Once outside, everything they learn is gone. Even if they do discuss the themes, they only favour one side, and as often the case, sex is the hot topic amongst the students. They may share their sexual experiences openly within groups and laugh away merrily, believing that such conversation provoke their inquisitiveness which only encour-ages the story teller to articulate the story with greater passion.Students who are serious about it tend to talk to those they trust and usually of the same gender. Often they talk about it in a secluded place for fear of being over-heard.To conclude, I believe that the need for further, sufficient knowledge of HIV and sex amongst the tertiary students are lacking. They should be actively involved in acquiring as much knowledge as possible about HIV and sex when still in school and from the media. With this knowledge they have the power to influence the public and contribute effectively to the fight against AIDS in our country.

Mr. Joseph Angli is a 3rd Year Health Management Student

Reference List

The National, (2002, March 12), 340 HIV/AIDS Cases recorded in 2 months., p.3National Department of Health. (2010) The 2010 Fourth Quarter STI, HIV and AIDS SURVEIL LANCE REPORT, Port Moresby: PNG GovernmentKelly, A. et al (2008). Young peoples’ knowledge and attitudes towards Sex and HIV in the Eastern Highlands Province. NSW: National Centre for HIV and Social Research.Abbott. C, Abraham. N, Adams. B, Adams. D, (2008). HIV AIDS. Microsoft Encarta Premium 2009. Redmond: One Microsoft Way

Beneficence in Health

ManagementArticle by Rayleen Wally

Beneficence is understood broadly in ethical theory, to include effectively all forms of ac-tion intended to benefit or promote the good of other persons (Beauchamp 2008).Health Care Organisations exist because there is a need for management of Health facilities and resources.The decisions that health man-agers make may sometimes have a clash with the decision of clinicians. This is because they have different roles with different professional code of ethics. But according to the principle of beneficence, whatever the decisions made, it must be beneficial to the greater number of good. In the health sector, the clinician has the responsibility to the patient and the Management team has the responsibility to the employees. They both work together to provide the greater good to the greater popula-tion and that is beneficence. The decisions that Health Manager takes must benefit the major-ity of the employees likewise the decisions that clinicians do must benefit the majority of the patients. The implication of beneficence on the health managers are the challenges that they face in order to manage professional and ethical standards. There are many issues in our health care organisations in the country that have breached the principles of beneficence and those breach of beneficence are often reported as corruption or mismanagement of funds. For example: It was reported in The National newspaper on 5th of March, 2012, of one of many cases that showed an example of a breach in the principle of beneficence in the public health system. The story was about the crackdown on the drug scam which saw eight people arrested from the Department of Health after it was found that K6 million was in a staff personal account who had just passed away. Prime Minister Mr. O’Neil said such an amount found in a public servant’s account is unbelievable. He said that the K6 million should have benefited the greater number of people in the country by providing medical supplies to the health care facilities where people are accessing these health care services. It is the people’s right to receive quality health care services therefore those who work in the health sector must apply the principle of be-neficence to see the greater number of people benefiting from their work.Rayleen Wally is a second year HM studentReferenceBeauchamp, T., (2008) The Principle of Beneficence in Applied Ethics, Retrieved from http://plato.stanford.edu/archives/fall2008/en tries/principle-beneficence/

DWU Students during the annual graduation ceremony. Photo from DWU website

Article by Benjamin Wusik

1. Health care systemFor every person, health is a basic need and is very important to sus-taining life.According to World Health Organisa-tion (WHO 1984) Health is defined as a “state of complete physical, mental and social well-being and not merely the absence disease or infirmity”. On the same note health care refers to the” activities that we do to maintain health which includes the provision of medical and related services aimed at maintaining good health, especially through promo-tion, prevention and treatment of diseases” (Samei, 2011). Further-more, the health care system is the complete network of agencies, facilities, and all providers of health care in a specified geographic area where nursing services are integral to all levels of health care services (Samei, 2011).

However, the health care system of Papua New Guinea is complex and consists of diverse structures and that these structures are important and vary from each other.These includes National Goals and Directives of the PNG Constitution, Health Laws, Key Health policies and different types and levels of Health Services such as Manage-ment Leadership, Medical Care, Public Health and Training of Health Professionals. The Health Care Sys-tem also include Health institutions like Hospital, Health Centers and Aid post. Others in the system are Non Government Organizations, Profes-sional Health Groups, Development partners and the Financing systems of the Health industry.On the other hand there are sev-en(7) essentials values of PNG Health care System which uphold the quality Health service delivery to the patients. These essentials values include Accountability, People Focused, Integrity, Equity, Quality, Diversity and the Teamwork. How-ever, the main aim of the health care system is to provide the best health care services to the people with af-fordable cost regardless of gender, race or qualification.According to Samei (2011) the “behavior and action of everyone in

upholding (7) essential values when doing health business activities will contribute to improving the following areas of Health.• Health Service Delivery• National Indicators• Standards of Living of indi-viduals, Family, Clan and Population.

2. Different levels of Health facility In the PNG health care system the three distinct parties that provide Health care services and take care of the Health facilities are Govern-ment run Health Facilities, Church run Health facilities and Non-Govern-ment or Private Run Health Facili-ties. However, these facilities provide different types of health care to the people depending on the facilities and resources they have. They also have different outpatient payment systems or medical fees for their services. Private health facilities usually have the patients pay for the services they receive. There are three levels of health facili-ties. These are Hospital, Health cen-ters and Aid Posts. These facilities are always related to each other in terms of referrals which always begin at the lower level to the higher level. For example patients are transferred from the Aid Post to Health Centre and to Provincial and National Hos-pital depending on the nature of the illness and available services and facilities on hand.However, all levels of health facilities have been collecting fees from the users but lack proper recording.This practice has been widely critisised and no corrective action has been taken so far. On the same issue, the National Health Plan 2011-2020 clearly describes what PNG will do

Overview of the PNG Health Care Systemto address health service delivery to the people. It relates and describes these commitment through the ele-ments as Slogans,Visions,Goals, Missions, Essentials values, Key re-sults Areas (KRAs) Implementation Plan and financing arrangements.

3. Key Health policiesAccording to Chief Professor Rein-hard Busse (2012) health policies are intended to be a vehicle for the exploration and discussion of the health policy and is aimed in par-ticular at enhancing communication between health policy and system researchers, legislators, decision-makers and professionals concerned with developing, implementing, and analyzing health. However health policy is defined as a statement of decision regarding a goal in health care and a plan for achieving that goal (Medical Dictionary, 2009). For example, to prevent an epi-demic, a program for innoculat-ing a population is developed and implemnted.It is also defined as a field of study and practice in which the priorities and values underlying health resources allocation are de-termined (Medical Dictionary, 2009).

Furthermore, there are linkages and different purposes for the key health policies. There are many different types of Health policies we have but in this document, due to simplicity, it will state only the key health poli-cies. Health policies will help you to understand the linkages between the Health Laws and Policies and how they relate to the value of Implemen-tation of the plans.According to Government of Papua New Guinea (2010) key health poli-cies include:

• Medium Term Development Strategy (MTDS)• National Health Plan 2011-2020• National and Provincial Stra-tegic Plans• National Department of Health Corporate Plan 2009-2013• Hospital Co-operate Plans

Furthermore a good health policy defines the health vision of a nation, establishes benchmark for its ac-

Mr. Wusik (in red shirt) has a look at some medical equipment a hospital recently

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complishment, outlines priorities and expected roles of each group involved, builds consensus and informs the public (WHO, 2000).

4. Impacts and challenges faced in the Health care systemOver the last decade, Papua New Guinea has struggled to provide quality health care services to its people. These challenges are influenced by both the geographical terrain and the common practice of corruption in the health care system. This includes the high cost of medical resources as Health care become modernized and mismanagement of funds and lack of honesty, transparency, leadership skills, support and care from Government. Three quarters of our population are illiterate and poor and often reside in rural areas of this country (NHP 2011). These people have no proper health services and access to roads. As a result, this affects the health status of the country causing it to decline despite of the huge amount of investments from the PNG government in to the Health System over the last decade (NHP 2011-2020).

Furthermore this influence by social indicators given in the National Health plan 2011-2020 and reported the poor health status as follows:• Infant Mortality rate (infant deaths per 1000 live births) 57.• Children under five years Mortality Rate (per 1000 live births) 75.• Maternal mortality rate (per 100,000 live birth) 733.• Life expectancy at birth - 54 years

To help solve these problems and challenges,we must make use of what is already available to us in our cur-rent system. The procedures and plans are already in the key health policies so it is a must that health be everybody’s business and our responsibility to make the change in the health care system. The challenge is for for health professionals to imple-ment knowledge and skills to improve the health of the population.

Benjamin Wusik is a 2nd Year Health Management Student

5. Reference List Busse R. (2012) Health Policy - Elsevier.Retrieved 7th April 2012 from http://www.elsevier.com/locate/healthpolGovernment of Papua New Guinea. (2010). National Health Plan 2011-2020, Vol. 1, Policies and Strategies. Port Moresby Samei.M. (2011). Introduction to Health care system. Unit 1 module 13.Unpublished marsupials.World Health Organization (1984). About WHO: Definition of Health. Retrieved 7th April from www https://apps.who.int/about who/en/definition.html.Medical Dictionary (2009).Health Policy [8th Edition]. Retrieved on 7 th April 2012 from http www.jointcenter.org. WHO (2000).Community Health and Wellness, Health Policy, 2nd edition, Australia: South wood press.

Article by Maryanne Idawa

Mismanagement and lack of medical equipments is one cause of the deterioration of Papua New Guinea’s public health service over the years (The National 2011). The U. S. Department of State (2010) claims that Papua New Guinea is one of the developing nations that faces challenges and problems in health due to lack of essential medical equipments in our health facilities. I have identifed some common problems experienced in the management of medical equipments in PNG:� Purchasing of very expensive medical equipments resulting in overuse of funds.� Break down of expensive equipments due to lack of spare parts or qualified personnel to maintain and keep the machine in service.� Lack of proper consultation for the donated medical equipments from the donors.� Lack internet service to get direct information from the suppliers (on line purchasing)� Medical equipments are old and outdated� Lack of inspection, maintenance and contractual repair agreement with the suppliers.� Great variety of models from different manufacturers� Design of medical equipments by industrialized countries where the environment, disease pattern, trained users and maintenance capabilities are different from our country.� PNG does not have a medical equipment manufacturer where we can go easily for repair and have easy access to medical equipments.� The major factor contributing to the mismanagement of medical equipments is lack of the in-house and biomedical technicians for acquisi-tion and monitoring of the equipments (WHO, 2008).For example, during a second year HM student’s six weeks practical at the Yagaum Rural Hospi-tal, there was an X-Ray machine available for use but there was no special-ist to use the equipment so it has been lying there unused and patients in need of this equipments are referred to the Modilon General Hospital� Mismanagement and lack of funding for the maintenance of medical equipments (The National, 2011)

RecommendationFor better management of the medical equipments in our country, the fol-lowing recommendations would be helpful: � Establish clear-cut national policy on acquisition, utilization, and maintenance of medical equipments.� Employ or train in-house technicians or biomedical engineers to monitor the equipments (Pickworth, 2011). � Train equipment users to do simple maintenance on the equip-ment to reduce equipment break down.� Keep the equipment inventory records safely. It is advisable to make copies of the manuals for distribution to the users, while the originals of the manuals should be kept for safe keeping.� All outdated medical equipments must go through the Board Of Survey (BOS).

The problem associated with medical equipments is ever increasing as health care becomes modernized. Apart from bringing in benefits, medical equipments also has its share of problems. These problems can be either a technical or an administrative one. The recommendations would help to solve some of the problems.

Maryanne Idawa is a 2nd Year Health Management student

REFERENCESU.S Department of State (2010) Papua New Guinea Country Specific Information, USA, Retrieved from: http:// travel.state.gov/travel/cis_pa_tw/cis/cis_996.html#medicalPickworth, R (2011) Living in PNG ha taught us to be resourceful, independent problem solvers, Meddent, PNG. Retrieved from: http://www.meddent.com.pg/about-us-2The National, (2011). ‘Health services worsening, accounts inquiry told’, The National, 26th October. Retrieved from: http://www.pnghealthpartnerships.org/

Continued from previous page...PROBLEMS IN THE MANAGEMENT OF MEDICAL EQUIPMENTS IN

PAPUA NEW GUINEA

From the Editor’s Desk

If you have any ideas, issues or comments concerning the e-newsletter, please do not hesitate to contact the editor, Mr. Kingston Namun at the Health Sciences Tower, DWU campus in Madang town. We welcome any suggestions to improve news quality, distribution or content of our newsletter. Here are our contact details: Email: knamun@dwu.ac.pg Ph: 424 1887. See you all in the next issue. This newsletter is endorsed by the Head Of Department for Health Management and the Dean of the Faculty of Health Science before its publication.

HM Department participates in 2012 DWU Open Day