Chapter 5 Delegation follow-up, concluding comments, and acknowledgements

1BDelegation follow-up

5.1                   Soon after returning to Australia the Parliamentary Relations Office organised a delegation debrief meeting with DFAT and AusAID officers.  Delegates discussed the execution of the program and provided feedback to the departments on the overall effectiveness of the programs in Papua New Guinea and the Solomon Islands.

5.2                   The Committee delegation invited the Papua New Guinean and Solomon Islands High Commissioners to a working lunch at Parliament House on 17 November 2009 to discuss the visit to their respective countries.  

5.3                   The delegation also arranged a series of meetings with relevant government ministers and parliamentary secretaries including the then Parliamentary Secretary for Pacific Island Affairs, the Hon. Duncan Kerr MP; the Parliamentary Secretary for International Development Assistance, the Hon. Bob McMullan MP; and the Minister for Indigenous Health, Rural & Regional Health and Regional Services Delivery, the Hon. Warren Snowdon (who has portfolio responsibility for the Torres Strait region). These meetings afforded the delegation a unique opportunity to be briefed by government members with portfolio responsibility for health matters in the region, share aspects of the visit, and discuss aid priorities.

5.4                   Committee delegation members also extended an invitation to the New Zealand High Commission to discuss the visit.  The Committee delegation was delighted to meet with Mr Vangelis Vitalis, the NZ Deputy High Commissioner in Canberra. Mr Vitalis provided delegates with a useful overview of New Zealand’s role in the Pacific and NZAID’s programs in Papua New Guinea and the Solomon Islands.

Concluding comments

5.5                   Not many Australians are aware that Australia’s closest international border is a few kilometres away from the Torres Strait and that Australia and Papua New Guinea share a unique treaty arrangement that permits free movement between treaty villages on either side.

5.6                   There has been a number of media reports in the last year or two intimating that there is an ‘influx’ of PNG nationals arriving in the Torres Strait via the treaty and that infection risks for communicable diseases like TB and HIV/AIDS are very high.

5.7                   The inquiry and delegation of the Health Committee sought to examine these issues in detail and hopes that this report goes some way towards highlighting the issues in their complexity, tempering some of the unsubstantiated fears, and reaffirming why we permit a relatively small number of sick PNG nationals access to health services in the Torres Strait, under specific conditions. We do so for humanitarian and practical reasons and because that’s what good neighbours do. The report shows that there exists a range of structures and systems in place for managing this process from treaty consultation processes through to Queensland health treatment guidelines. There are costs associated with treating these individuals and while the numbers treated are small, costs for serious conditions like MDR-TB are not insignificant. It is in everyone’s interests to try and mitigate against these.

5.8                   The Committee heard and saw for itself some of the push factors why treatment may be sought on the Australian side. There are vast disparities between health facilities in PNG and those in Australia. Major challenges on the PNG side include a lack of human resources, equipment and infrastructure coupled with rugged geography and governance issues that make difficult the distribution of essential supplies and service delivery. The Committee learnt that the problems are not solely due to a lack of money, especially in Western Province, which is actually one of the richest provinces in the country.

5.9                   Australian aid in the region is substantial and seeks to strengthen health facilities along the border in Western Province as well as to strengthen the national health systems in PNG and SI alike. Extra resources are being allocated to Saibai health clinic in recognition that it caters for PNG nationals in addition to Torres Strait residents. Whether those sums are sufficient is subject to ongoing review. 

5.10               The Office of Development Effectiveness reports indicate that overseas aid effectiveness is a mixed bag, more successful in some areas and/projects than others. Placing Australian advisors in in-line agencies like the Ministry of Health to work alongside host counterparts in the Solomons is one strategy that appears to work well. On overseas aid it is worth mentioning something not well-known. Assistance flows two ways. For instance, PNG provided aid to Australia, for its victims of natural disasters in the Victorian bushfires and Queensland floods.

5.11               Australia works in partnership with the governments of PNG and SI to achieve better health outcomes and determines priorities in both countries in line with what those governments want.

5.12               PNG and the SI are sovereign nations and Australia can and only wishes to assist. Ultimately the PNG and SI governments are responsible for delivering health services to their own citizens.

5.13               In this report, the delegation highlights the problems but also what works or could work better and Australia’s role in facilitating solutions.

5.14               For instance, Australia has clearly made a fundamental difference to the water and sanitation situation in treaty villages in the Western Province of Papua New Guinea through supplying rainwater tanks that provide a minimum level of safe drinking water. The delegation has recommended that this installation program be expanded to provide more than the minimum level of water required. Installing adequate water and sanitation in villages is part of getting the basics right for better health outcomes. The delegation notes that the PNG government together with Sustainable Development have undertaken to improve water reticulation and would like to see this done as soon as possible. That said, the delegation recognises the very real logistical and practical difficulties that stand in the way of any speedy or comprehensive installation.

5.15               In the Solomon Islands, Australia has built basic but functional health clinics, complete with solar fridges for cold storage of vaccines. 

5.16               The delegation learnt that one-off projects, supply deliveries and volunteer or staff placements can sometimes do more harm than good, despite donors’ best intentions. The Committee has recommended that a contact point be established that provides community organisations with basic information on the suitability of their intended donations in the region.

5.17               Similarly, when building new health facilities or offering other goods and services to assist, the Australian government and Australian community organisations must consult donor partners and local communities. New health facilities must be cognisant of the suite of support measures that will need to be put in place for staff and to maintain that new structure.

5.18               The delegation heard from nearly everyone it met with during the visits about the huge benefits of twinning arrangements between health institutions in our respective countries, be these hospitals, laboratories, universities, or parliaments. Developing and maintaining institutional relationships are not up to governments per se, rather the institutions themselves. However, the delegation has recommended that the Australian government do all that it can to encourage and support sustainable schemes and exchanges.

5.19               Fostering greater people-to-people links, genuine exchange and sharing of information and training lies at the heart of a new era of reengagement and underscores true partnership.

5.20               Myriad benefits are being reaped from the Australian Leadership Awards, the relationship that exists between the Solomon Islands Parliament and the NSW Parliament, and courses like the Australian National University’s Centre for Democratic Institution’s “Women in Politics Course”, designed to assist participants from the region get more women elected in their national parliaments.

5.21               The delegation hopes to see more women parliamentarians elected in the region in coming years, and for the Australian Parliament to do all it can to support that process. Hence, our recommendation to the presiding officers to establish a parliamentary mentoring program especially for women MPs. The delegation believes such a program would have reciprocal benefits for, and enrich all our parliaments.

5.22               This inaugural committee delegation visit to PNG and the SI was the first joint parliamentary delegation in recent memory to the treaty villages and, indeed, the first parliamentary health delegation in recent memory.

5.23               The symbolism of such a visit is very important. The delegation visit was warmly welcomed by our respective governments at the highest levels at the national and provincial levels, institutions and community organisations. Delegates were also made to feel incredibly welcome in the villages and were privileged to spend time in villages that are not easy to get to in the western provinces in both PNG and SI. Wherever the delegation went it experienced and shared the goodwill that exists between the people of Australia, Papua New Guinea and the Solomon Islands.

5.24               Of course governments must go beyond symbolism and beyond in-principle agreements, to fund and implement the better health infrastructure and services that are required on both sides of the border. That is something which the Australian and PNG governments have both undertaken to do with the new Package of Measures which is designed to strengthen health services on both sides of the border. This package is in its infancy but already, the delegation heard, measures such as installing health communications officers on both sides of the border are proving effective. The delegation has recommended that consideration be given to expanding such positions in the future because their job is so vital and possibly beyond the capabilities of any one or two individuals. The delegation was told that close communication between partners is key to any program’s success, including that achieved by the national malaria program in the Solomon Islands.

5.25               The delegation was fortunate to be able to meet with Ministers, parliamentarians, health professionals and communities, for discussion on a range of health issues from TB, HIV/AIDS, and malaria to the rise in diabetes and the encroaching impacts of climate change on health.  All dialogue was conducted in a frank and open manner.

5.26               Delegates were especially impressed, and indeed humbled by, all the health professionals and community workers that they met with up in the Torres Strait, in PNG and in the SI, who are so clearly committed to providing the best patient care they can under the circumstances, often with limited tools and support. They are the unsung heroes of any health system.

5.27               Beyond aid, PNG and SI require robust integrated health care systems, that incorporate a range of outreach services in outlying areas. Australia has rural and remote areas that governments find difficult to service too.

5.28               PNG and the Solomon Islands are not alone in grappling with how best to deal with moving a fragmented health system to a less fragmented one. Australia has long struggled with the issue of major health reform, and still debates what level of government (national, state or local) should take responsibility for health services funding and delivery. Major structural reform is again, today, on the agenda in Australia. We have something fundamental in common here. Similarly, we must all deal with the impact of climate change on health. Let us share our experiences and learn from each other about what does and does not work so well.

5.29               The delegation visits played a role in that sharing and learning process. Delegates hope to see the parliamentarians we met in PNG and SI back in Australia in the near future to continue our engagement. It is so important for leaders and communities in our respective countries to have ongoing dialogue about the range of health issues that affect our region.

5.30               The Committee firmly believes that the travel provided a valuable platform for committee members to learn more about issues relevant to their portfolio and to build parliament and other people-to-people contacts in the region. Such purposeful travel, in conjunction with an ongoing inquiry, considerably enhances committee work and the work of the Parliament.

Acknowledgments

5.31               On return to Australia, the delegation sent thank you letters to all those with whom it met and/or helped to coordinate the delegation visit. Copies of photos taken with the delegation were also mailed as a courtesy.

5.32               In addition to the individuals listed below, the delegation wishes to record its appreciation to everyone else who worked ‘behind the scenes’ to ensure that the visit went so smoothly.

4BPapua New Guinea

5.33               The Australian High Commission in Port Moresby are to be commended for organising an excellent program.  The delegation thanks the Australian High Commissioner, His Excellency Mr Chris Moraitis, and staff for their generous hospitality and assistance during our week’s stay.  We extend thanks to the Deputy High Commissioner, Mr John Feakes;  senior AusAID officers Dr Anne Malcolm  and Ms Fiona Cornwall, and Mr Adrian Lochrin and Mr Paul Murphy, DFAT Counsellor and DFAT First Secretary respectively, for accompanying us on engagements throughout the week. We appreciated their counsel and good company.

5.34               The delegation greatly appreciated the opportunity to meet with members of the PNG Parliament and Government in Port Moresby including the Minister for Health and HIV/AIDS, the Hon. Sasa Zibe MP; the Minister for Community Development, Dame Carol Kidu CBE MP; and Chair of the Special Parliamentary Committee on HIV/AIDS Advocacy, the Hon. Jamie Maxtone-Graham MP, MBE. We also acknowledge the senior executive that we met with including the Secretary for Health, Dr Clement Malau; the Executive Manager for Public Health, Mr Enoch Posanai; and Mr Wep Kanawi, Acting Director of the National Aids Council Secretariat.

5.35               The delegation makes special mention of the Hon. Bob Danaya MP, Governor of Western Province, and the Hon. Sali Sabam MP, Member for South Fly. Without these two our visit to the Western Province and treaty villages would not have been possible, or indeed the special experience that it was. We are very grateful for all that they did to make us feel so welcome in their constituencies; their warm hospitality, counsel and company on our visits to Mabadawan, Sigabadaru and Buzi.

5.36               The delegation was pleased to conduct a range of site visits in Port Moresby and thanks the following individuals and organisations for taking the time to show delegates around and talk with them about their work: Mr Christopher Hershey, Project Manager, staff and volunteers at Poro Sapot; Ms Annie McPherson, Secretariat Coordinator and staff at Igat Hope; Sir Isi Kevau, Executive Dean and Professor of Medicine and Professor John Vince, Deputy Dean and Professor of Child Health at the University of Papua New Guinea’s School of Medicine and Health Sciences; Dr Jambi Garap, Head of PNG Eye Care Vision Centre and Optical Workshop and staff; and Mr Geoff Clarke, Technical Advisor and staff at Susu Mamas.

5.37               Delegates appreciated the opportunity to meet with other civil society and government representatives and health administrators throughout the week to discuss health issues, including Ms Caroline Bunemiga, General Manager, Business Against HIV/AIDS; Dr Joseph Palagio, Secretary of Education and Dr Mathias Sapuri, Medical Society President.

5.38               We were met in Daru by a delegation from the Western Province provincial administration. We thank Mr William Goineau, the Provincial Administrator, and his staff including, Mr Wonalam Gire, Protocol Officer and Mr Frank Botude, International Coordinator, Department of Social Services, for providing such an impressive welcome at the airport on our arrival and the ‘sing sing ‘entertainment later that evening.

5.39               A special thank you is extended to the treaty villages of Mabadawan, Sigabadaru and Buzi in Western Province for hosting our visit. We received extraordinary welcomes in each village. Hundreds of villagers came out to greet us, showcasing magnificent traditional singing, dancing and culture. We are indebted to the following Councillors in the respective villages: Mr Kebei Baduwame of Mabadawan; Mr Kebei Sale of Sigabadaru; and Mr Frank Wappa of Buzi. We also thank the health workers who gave us a tour of their health facilities; the organising committees; those who provided refreshments, made leis and the women’s fellowship group at Sigabadaru who presented the delegation with beautiful handicraft gifts. We have fond memories of all the people we befriended that day.

5.40               We were grateful for the opportunity to meet with a number of Western Province health managers and health workers at our site visits to the Provincial Health Office and Daru hospital including, Mr Alois Nakemole, South Fly District Health Manager; Mrs Alice Honjepari, Director of Rural Health Services; Dr Amos Lano, CEO of Daru Hospital; Dr Sidney James, Director of Medical Services; Dr Abel Marome, Senior Clinician at Daru Hospital; Ms Lilian Motup, TB Project Officer; Sister Rita, Home of Good Hope, HIV Clinic; Dr Naomi Pomat, Health Communications Officer (AusAID funded); Mr Geoff Miller, Provincial Health Capacity Building Advisor (AusAID advisor); and Ms Lucy Morris. We aknowledge the presence of representatives from PNG Sustainable Development Ltd at the meeting at the hospital.

5.41               The delegation was pleased to participate in an inter-sectoral meeting on treaty village development and thanks the treaty village chairman, Mr Sisia Kimia, and others for taking the time to meet with the delegation on a Saturday.  In addition to some of the individuals listed at paragraph 5.14 who also attended this forum, we acknowledge the following attendees: Mr Willi Kokoba, Deputy Provincial Administrator; Mr Michael Viriu, South Fly District Adminstrator; Mr Jimu Alphones, Police Station Commander; Mr Babela Kalama, Principal Advisor, Department of Agriculture and Livestock; Mr Dick Jogo, Principal Advisor, Fisheries; Mr Melchoir Rokuman, Program Agriculture Officer; Mr Philemon Abe, Agriculture Officer; Mr Les Ture, Immigration Officer; Mr Netsely Baerey, Principal Advisor, Education; Mr Renagi Raga, Director of Social Services; Dr John Ibale, Director of Economic Services, Department of Social Services; and Mr Karl Yohang, Commerce Advisor, Department of Social Services.

5.42               The delegation also wishes to acknowledge Corporal Mark Gadimilo from the Royal Papua New Guinean Constabulary and Federal Agent Mark Atkins for accompanying the delegation in a security and protection capacity throughout the week.

Solomon Islands

5.43               The delegation is most appreciative of the fine support and assistance it received from the Australian High Commission in the Solomon Islands,  His Excellency Mr Frank Ingruber, and staff, including Deputy High Commissioner, Ms Alison Duncan and Ms Angie Kovaloff and Ms Angellah Kingmele of AusAID.  Particular thanks go to Mr Kamal Azmi, Counsellor, Development Cooperation, and Mr Justin Baguley, Senior Development Program Specialist, who took considerable time out from their working week to accompany us to meetings and, in Mr Baguley’s case, travelling out with us to Western Province.  We greatly appreciated the effort put into developing such an interesting program and the care that everyone took to ensure that the delegation was well-informed and well-looked after during the week.

5.44               The delegation greatly appreciated its engagements with members of the Solomon Islands Parliament including the Deputy Prime Minister of the Solomon Islands, the Hon. Fred Fono MP; Speaker of the National Parliament, the Rt Hon. Sir Peter Kenilorea; and Health Minister, the Hon. Clay Forau MP.

5.45               The delegation enjoyed its tour of the National Parliament Chamber from the Sergeant-at-Arms Mr Chris Forau.

5.46               We were fortunate to meet with a number of agency staff in Honiara who provided informative insights into a range of health issues.

5.47               The delegation thanks the following Australian Leadership Award Fellows who participated in a working lunch with delegates : Mrs Verzilyn Isom, Head of Nursing School, Solomon Islands Higher College of Education (SICHE); Mr Michael Larui, Director of Nursing, MHMS; Ms Sanet Talo, Registrar, Nursing Council; Mrs Jessie Larui, Lecturer, SICHE Midwifery School; ,Mr Stephen Kole, Clinical Nurse Consultant, NRH; Mr Amos Lapo, Director, Primary Health Care; Mr Selwyn Hou, Director Nursing, NRH; Mr Abraham Manomokari, Director of Planning, MHMS; and Mrs Hellen Orihao, Nurse Educator, NRH.

5.48               The delegation also thanks Dr Tenneth Dalipanda, the National Referral Hospital Medical Superintendent, hospital CEO Douglas Ete and Deputy Director of Nursing Rachel Wate for showing us around the hospital and providing a comprehensive overview of its facilities and services. We extend our thanks to all the staff that we met during the tour including those in the diabetes clinic and microbiology lab.

5.49               Delegates were pleased to meet with their parliamentary committee counterparts on the Special Select Committee Inquiry into the Quality of Services at the National Referral Hospital to learn about their inquiry. We thank the Chair of the Committee, the Hon. Peter Boyers MP and his colleague, the Hon. John Patteson Oti MP, for taking the time to meet with us.

5.50               The delegation valued meeting with Mr Alby Bobogare, Director of the Vector Borne Disease Unit, and colleagues, to discuss the national malaria program.

5.51               Delegates are grateful to senior RAMSI staff, namely, RAMSI Special Coordinator, Mr Graeme Wilson; Acting RAMSI Development Coordinator, Mr James Hall; Acting Commander Participating Police Force (PPF), Anne Dellaca; and Deputy Commander Combined Task Forcer (CTF), Stuart Brown, for providing an update on the status of RAMSI activities.

5.52               The delegation thanks the Western Province Premier, the Hon. George Solingi Lilo for welcoming us warmly to the Province, and the members of his government with whom we met including, the Deputy Premier, Robert Pae Kuve, and ministers, including, the Health Minister, the Hon. Sutcliff George and Education Minister the Hon. Victoria Sino. We also acknowledge the assistance of executive staff such as the Provincial Secretary, Mr Arnold Moveni.

5.53               The delegation appreciated its tour of Gizo hospital and thanks health staff including the Acting Health Director, Dr Michael Buin; Hospital Secretary, Mr Alfred Vilaka; and Director of Nursing, Western Province, Mr Charles Sigoto, for providing us with an overview of the Province’s health services.

5.54               Visiting Vonunu Area Health Centre and Vonunu High School on Vella Lavella Island in Gizo Province was a real highlight of the delegation visit and we are most appreciative of the warm welcome we received, and the tour of the clinic and school. We met many people but especially thank the Chairman of the health centre and the Clinical Nurse-in-charge respectively, Mr Amos Zamo and Mr Francis Sirobui; and the Principal of the High School, Mr Wayne Koebule.  It was a pleasure to meet and talk with a number of high school students.

5.55               The delegation also wishes to thank Senior Sergeant Gorae for escorting delegates during our time in Western Province.

5.56               On its return to Honiara, the delegation hosted two valuable roundtable forums to discuss a broad spectrum of health issues: the first, with senior executive staff from the Ministry of Health; and the second with development partners and NGO representatives. The delegation thanks all the invited participants for their input in these sessions. In addition to some of the Australian leadership fellows we met earlier in the week, these included the following Ministry of Health staff: Dr Junilyn Pikacha, Reproductive Health Director; Mr Alby Lovi, Health Promotion Director; Mr Robinson Fugui, Environment Health Director; Dr Nemia Bainvalu, Communicable Disease Director; Mr William Same, Mental Health Director; Mr Aaron Olofia, Social Welfare Director; Ms Elsie Taloafiri, CBR Coordinator; Dr Divi Ogaoga, Medical Officer, Child Health; Dr Wale Tobata, Director, Pharmacy; and Dr Baakai Iakoba, Chief Statistician.  Other participants included Mr Michael Saleni, Director of the Solomon Islands Planned Parenthood Association (SIPPA); Ms Lilian Sauni, Malaria Coordinator, Secretariat of the Pacific Community; Ms Yoko Asano, JICA Solomon Islands Office; Mr Brett Cowling from World Vision; and Ms Jennifer Wiggans, Country Program Manager, Australian Volunteers International.

5.57               The Committee delegation was also delighted to meet with a number of Australian volunteers during the week, working for VIDA, AVI and AYAD volunteer programs. We especially thank the AYAD volunteers who participated in the Ministry of Health roundtable, Mr Michael Nunan and Ms Ruth Langmead, who were working in the hospital pharmacy and disability sector in the SI, respectively.

6BAustralia

5.58               The Committee highly valued the input of His Excellency Mr Charles Lepani, Papua New Guinean High Commissioner to Australia and His Excellency Mr Victor Ngele, Solomon Islands High Commissioner into the inquiry and delegation visit.

5.59               The Committee extends thanks to all the other witnesses (listed individually in Appendix B) who participated in inquiry activities including private briefings, hearings and inspections, in Canberra, Cairns, Thursday Island and Saibai Island. 

5.60               We also thank Mr Brett Young, the DFAT Treaty Liaison Officer on Thursday Island for his hospitality and role in facilitating our visit in the Torres Strait.

5.61               Committee delegation members appreciated the comprehensive oral and written briefings delegates received from DFAT and AusAID officers prior to the delegation.  We thank the following DFAT officers: Mr Geoff Tooth, Assistant Secretary PNG and Fiji Branch; Ms Heidi Bootle, Director Solomon Islands Section; Mr Colin Milner, Director PNG and Torres Strait Section, and the following AusAID officers: Ms Ellen Shipley, Acting Assistant Director-General, Papua New Guinea Branch; Ms Jennifer Lean, Manager, Cross-cutting analysis, PNG Branch; Ms Debbie Bowman, Director Human Development, Pacific Branch and Mr Tim Gill, Manager, Pacific Health, Pacific Branch.

5.62               The delegation acknowledges assistance received from the parliamentary library research staff who prepared the delegation’s aims and objectives. These served as a useful guiding framework for the visit.

5.63               Delegates extend their appreciation to the Parliamentary Relations Office of the Department of the House of Representatives, in particular, Ms Lynette Mollard, Senior Visits Officer, for her role in coordinating the delegation’s program, travel and administrative arrangements.

5.64               The delegation thanks the then Parliamentary Secretary for Pacific Island Affairs, the Hon. Duncan Kerr MP,  for his support of the delegation visit from the outset, including meeting with delegates during the visit and afterwards. Input into the program from Mr Kerr’s staff including Chief of Staff, Mr Alopi Latukefu, and advisor, Ms Sarah Bilney, was also appreciated.

5.65               The delegation also thanks the Parliamentary Secretary for International Development Assistance, the Hon. Bob McMullan MP; and the Minister for Indigenous Health, Rural & Regional Health and Regional Services Delivery, the Hon. Warren Snowdon for meeting with delegates on their return to Australia, and being equally supportive of the visits.

5.66               Finally, the delegation valued the opportunity to meet with the NZ Deputy High Commissioner, Mr Vangelis Vitalis, to discuss Australia and New Zealand’s mutual interests in the region and coordinating our development assistance.

Mr Steve Georganas MP

Chair

March 2010