Chapter 4
Addressing health issues in Torres Strait
4.1
Despite the Treaty excluding health matters as a valid reason for travel
under its freedom of movement provisions, the committee found that inadequate medical
services in PNG encourage people from Western Province to seek health care on
Torres Strait Islands. The committee noted the lack or absence of health
services in PNG Treaty villages, shortage of staff and equipment and the long
distances required to travel to seek medical assistance.
4.2
In this chapter, the committee explores the various government
initiatives designed to build PNG's capacity to deliver health services to the
Treaty villages so that people from these communities seek medical treatment in
their own province. It is especially interested in the long term benefits that
result from Australia's development assistance to Western Province. First, the
committee looks at measures targeted at improving health services in PNG.
Health challenges in PNG
4.3
Many witnesses spoke of the need for Australia to help PNG improve its
health facilities and the standard of health care in Western Province. The TSRA
submitted that 'health care capacity and the quality of infrastructure in the
Western Province have to be raised in order to reduce cross-border pressure on
Torres Strait community health services'.[1]
Mayor Gela, TSIRC, highlighted the need for Australia 'to ensure that
appropriate health infrastructure is provided' within this province.[2]
The Torres Shire Council suggested that a major upgrade would benefit the Daru
Island hospital or that health clinics at centre villages such as Mabadauan could
be built to facilitate access to ongoing support programs.[3]
4.4
In this regard, Mr Kenny Bedford, TSRA Portfolio Member for Fisheries
and Member for Erub Island, observed that state and Australian government health
agencies have finally realised that 'there needs to be a lot more resources and
attention given to the other side of the border'.[4]
He recognised that Australia is reducing the risk on its side by 'setting up
medical centres and health facilities on that side that help deal with the
issues over there before they fall on our doorstep'.[5]
Joint initiatives
4.5
For decades, Australia has provided assistance to PNG to help it improve
its health system and together with PNG has initiated a number of strategies
and agreements.[6]
Currently, the Papua New Guinea–Australia Partnership for Development agreement
is the guiding and practical framework for development work. It was signed by the
respective governments in August 2008 as part of the Australian Government's
wider initiative to improve cooperation between Australia and its Pacific
island neighbours. The agreement aims to 'accelerate progress towards the
Millennium Development Goals (MDGs) and other PNG development priorities'.[7]
Through the agreement, a greater proportion of Australian Government funding
will be provided for the implementation of district health priority outcomes.[8]
4.6
The agreement supports the PNG Government's efforts in five priority outcomes.
Priority number three, 'Improved Health Outcomes', focuses on the
implementation of the PNG Government's National Health Strategies and Plans,
including reducing the prevalence of malaria and tuberculosis.[9]
Key areas of focus within this priority outcome include:
-
improved and expanded delivery of primary health care at
provincial, district and facility levels, and efforts to ensure that funds are
appropriately matched to the cost of delivery and channelled to basic service
delivery; and
- support for national functions needed for an effective health
system, such as service delivery planning, budgeting and procurement, health
worker training and new service delivery models.[10]
4.7
Ministers at the 2009 Ministerial Forum between Australia and PNG
announced three new priority outcomes, including HIV/AIDS.[11]
The joint statement from the PNG–Australia Bilateral Meeting in July 2010 noted
that in releasing six million kina to meet the costs of treating AIDS,
tuberculosis and malaria, PNG had made an 'important first step' towards
fighting these diseases.[12]
4.8
The Australian Government, through AusAID, is working with the PNG
Government 'to strengthen the national health system over the long term',
assisting in the delivery of immediate essential health services through the funding
of non-government organisations.[13]
Australia's country program allocation to the PNG health sector was
approximately $45 million in 2009–10.[14]
The funding is aligned with the health priorities of the PNG Government and
supports the institutional strengthening and sustainability of the PNG health
system.[15]
A number of other initiatives targeting particular health issues have also been
introduced. But improving PNG's health system is a major challenge. Ms Nardi observed:
I think there is a lot of work that has been occurring,
particularly with foreign aid at a Commonwealth level, with Papua New Guinea,
and I think that work needs to continue. But there are no easy solutions for
this. If there were an easy solution, it would be in place now. This is going
to be a long-term process about trying to upgrade and support health care and
healthcare provision in Papua New Guinea.[16]
Health initiatives for Western Province
4.9
Western Province, particularly the South Fly District, is an important
region to the residents of the Torres Strait Islanders due to its proximity and
is thus of most relevance to the committee's inquiry. As noted in the previous
chapter, inadequate, inappropriate or poorly administered funding is a major
impediment to improving the standard of health services, especially for rural
and remote areas such as the South Fly District.[17]
4.10
Although Australia provides significant amounts of aid to PNG, there are
limits to the extent to which Australia can determine how its funding is to be
targeted. Even so, according to Ms Shipley, earmarking of funds was possible under
the Partnership for Development. She explained that the 'issues that are of
particular relevance to Western Province and the Torres Strait area are very
similar to those priorities identified under that [partnership] and we do have
quite significant consultations with the government of PNG to make sure funding
flows'.[18]
4.11
The committee now turns to look at initiatives in place to improve
health in the South Fly District, PNG.
4.12
The governments of Australia, PNG and Queensland have worked together
since 2003 to address health issues arising out of the Treaty arrangements. The
countries established a Torres Strait Cross Border Health Issues Committee
(HIC) under the Torres Strait Treaty 'to examine health issues associated with
the free movement of PNG nationals and Torres Strait Islanders'.[19]
The HIC is chaired by DoHA and includes representatives from various Australian
government agencies, Queensland Department of Health and Department of Premier
and Cabinet, PNG Government and Western Province Administration.[20]
The committee meets twice yearly in Australia.[21]
4.13
To improve access to health services for traditional inhabitants in the
PNG Treaty villages, the 2008 Australia–PNG Ministerial Forum asked HIC to
develop a Package of Measures to resolve cross-border health problems.[22]
One of the aims of the package was to 'reduce the incidence and transmission of
communicable diseases', such as tuberculosis.[23]
Ms Fay Holden, DoHA, outlined the range of different measures contained in the Package
of Measures that are designed to assist both sides of the border to deal with health
concerns and relieve the pressure on Torres Strait health clinics caused by PNG
nationals seeking treatment. The primary ones include:
...redevelopment of Daru General Hospital and upgrading of the existing
aid posts to community health posts, commencing with the upgrade of the Buzi
Aid Post to a two-person community health facility...upgrading and improving the
Mabudaun and Kunini health centres...developing a training school for Rumginae
community health workers, strengthening their key public health programs,
health promotion and community awareness, the establishment of a system of
outreach programs, strengthening their human resource capacity, improving transportation
within the Western Province, a community water supply project, and assessment of
and improvements to the laboratories at Daru General Hospital and at the Mabudaun,
Wipim and Kunini health centres.[24]
4.14
A number of these initiatives have been or are being implemented. For
example, the House of Representatives Health and Ageing Committee noted in
their report that the Mabadauan health clinic was going to be upgraded to a
rural district hospital to provide easier access to health services to South
Fly residents.[25]
4.15
In its 2010 budget, the PNG Government allocated five million kina for
the Package of Measures, 'with a view to increasing this funding to 12 million
kina in 2011'.[26]
DoHA informed the committee that PNG had moved to provide enhanced funding for
some commitments under the package, including funding towards their laboratories,
but that some elements were still awaiting funding commitments. According to Ms
Holden, PNG's Department of Health is 'working through the implications of how
the funding that they had identified for this current financial year relates to
the proposals that they had in the package of measures'.[27]
4.16
In the previous chapter, the committee noted the difficulties with funding
and the allocation of funds for health in PNG. This problem applies also to the
Package of Measures. DoHA observed that 'access to supplementary budget funding
is essential to PNG implementing' the package.[28]
In addition, Ms Gardner noted that 'one of the biggest risks is still that [the
cooperation between agencies] relies on increasing the capacity within the
Western Province and the activities of the Papua New Guinea government and
ensuring that the funding and the commitments on that side are maintained'.[29]
Australia's commitment to the Package
of Measures
4.17
In its 2009–10 Budget, the Australian Government allocated $13.8 million
over four years for the Torres Strait Health Protection Strategy, administered by DoHA.[30]
Ms Bryant explained:
Our activities through the health issues committee focus on a
number of key things. One is trying to build the health service capacity in the
Western Province...so that they can provide services directly to their own
nationals. We also look at improving communications and linkages across the
border as well as the maintenance of health services.[31]
4.18
AusAID is involved in developing the PNG health system. It does not undertake
direct activities in Western Province but supports the Package of Measures
through a number of initiatives, including facilitation of the relationship
between the PNG Department of Health with the provincial and local governments
to ensure the flow of funds and effective use of their resources.[32]
Specific funding has been allocated to projects such as STI clinics,
tuberculosis management, communication officers and capacity building
initiatives in Western Province.[33]
4.19
The Tuberculosis Clinical Management and Laboratory Capacity Building Project
is one such initiative, which:
...looks specifically at helping to improve diagnosis and
treatment of TB in the Western Province, including in the Daru hospital, and it
looks to strengthen PNG’s diagnostic capabilities in the laboratory in Port
Moresby and so on. So there is funding to improve the laboratory and then train
and support staff working in the laboratory.[34]
4.20
According to DoHA, funding goes toward providing a database of PNG
nationals diagnosed with tuberculosis in island health clinics to the Western
Province Communications Officer.[35]
This is to enable data 'dissemination to appropriate health care workers at
Daru General Hospital and in Treaty village aid posts or health centres'.[36]
4.21
The Queensland Government highlighted the importance of AusAID working
closely with the PNG Government to ensure the effective implementation of the
Package of Measures. In its view:
...it is imperative that the Australian Government works
cooperatively with the PNG Government to ensure that the proposed Health
Package of Measures in PNG is well targeted and implemented to ensure optimum
service outcomes in the PNG Treaty villages...The Australian Government could
consider whether this is an appropriate area of action for AusAID.[37]
Committee view
4.22
The committee acknowledges the need for the Australian Government to
address health service provision in Western Province. It supports the initiatives
of the Australian and PNG Governments to establish new, or improve existing,
health facilities in the province.
Recommendation 1
4.23
The committee recommends that through the Package of Measures developed
by the Health Issues Committee, the Australian Government continue to support
PNG initiatives to establish new, or improve existing, health facilities in
Western Province so that PNG nationals no longer need to seek health care in
the Torres Strait.
4.24
The committee is concerned about the problems with funding arrangements,
such as the targeting and allocation of health funds in PNG and its
implications for the effectiveness of Australia's development assistance. This
aspect of Australia's aid is discussed later in this chapter. In the next
section, the committee turns to examine twinning arrangements, another
initiative between Australia and PNG to improve the quality of health service provision
in Western Province.
Twinning arrangements
4.25
Based on findings from previous inquiries, the committee appreciates the
value of using twinning arrangements to deliver development aid. This approach,
whereby PNG officials work for a period alongside Australian officers in
Australia and vice versa, could be used to build capacity in Western Province.[38]
It would encourage the development of new linkages between PNG and Australian research
and health institutions and strengthen existing ones. One suggestion arising
out of a House of Representatives inquiry was establishing a Western Province
Australian Clinicians Network to support capacity building at Daru Hospital and
the South Fly area.[39]
The committee supports such proposals.
4.26
In this regard, Queensland Health has commenced scoping a memorandum of
understanding for a twinning arrangement between it and PNG to exchange and
share ideas and skills. It is also looking to provide direct assistance and
support to PNG in capacity building to manage demand and reduce the need for
PNG nationals to visit health clinics on Torres Strait Islands.[40]
Services such as those of a respiratory specialist are among initiatives that
could be considered for twinning arrangements. Ms Nardi observed that due to
the service being used mainly by PNG nationals, it 'might be better off being
flown into Papua and delivering the service there rather than necessarily
delivering it in our clinics'.[41]
4.27
The Queensland Government informed the committee that it was 'finalising
a funding agreement with the Commonwealth which would allow PNG clinicians to
travel to the Torres Strait clinics to increase knowledge and skills in TB
management'.[42]
Cross-border movement of health professionals
4.28
Cross-border movement of health workers from Torres Strait islands of
Saibai and Boigu to PNG treaty villages offers the potential to improve the
delivery of health services in these villages. Under current immigration regulations,
however, health workers who are to deliver health services in PNG, including
the villages immediately adjacent to the Torres Strait, are required to travel via
the declared ports, for example those of Thursday Island and Daru in the Torres
Strait region. Considering the difficulties travelling around the region, this requirement
is a considerable imposition, especially since Saibai and Boigu are only a few
kilometres off the PNG south coast. DoHA explained:
Travel by health workers and other government officials
dealing with Torres Strait Treaty matters between islands in the Torres Strait
and Treaty villages along the South Fly Coast is both expensive and time
consuming...There is need for an alternative that allows identified health
workers and other government officials to travel directly between Saibai and
Boigu Islands in the Torres Strait and Treaty villages in the South Fly.[43]
4.29
Mr Bedford supported the endeavours that would allow doctors and nurses to
travel under the same sort of arrangements that exist for traditional visits 'so
that they do not have the rigmarole of customs and such to get over there'.[44]
This freedom of movement for health workers would not only reduce time and cost
but could ease the demand from PNG nationals for access to such services in the
Torres Strait.[45]
4.30
As part of the HIC Package of Measures and in consultation with relevant
agencies, DFAT developed a draft proposal for 'facilitated cross-border
movement' through non-proclaimed ports in the Torres Strait, Saibai and Boigu.
The joint proposal between the Australian and PNG Governments was designed:
... to streamline administrative arrangements for cross-border
movement by specified health officials and professionals, as well as for
nominated officials from other agencies e.g. border enforcement agencies.[46]
4.31
The joint statement from the July 2010 PNG–Australia Bilateral Meeting
noted that the arrangements for the cross-border movement of government
officials and health professionals had been formalised.[47]
The proposal is to receive funding of $5,000 per year until 2012–15 from
Australia as part of the Torres Strait Health Protection Strategy. It should be
noted that the scope of the proposal is confined to the administrative costs
that would still be associated with the cross-border movements.[48]
Ms Holden informed the committee:
It is not expected, especially in its early development, to
be a widely used facility. In terms of the health professionals and in relation
to health, we would anticipate around four to five movements a year under that.
The purpose of facilitated cross-border movement is primarily to reduce the administrative
burden and to make it easier to move between Saibai and the Western Province villages.[49]
4.32
She highlighted the point that the project was 'certainly not intended
to be for the provision of health services': that it was a health exercise in
terms of better management of referrals back to the health services:
The intent of that movement is not the treatment of PNG
nationals, in terms of Australian medical professionals going over to the
Western Province to treat people, but to build relationships and awareness of
the health service capacity that is in the Western Province, so that they can
better manage referrals back to those health clinics and also so that the
health professionals that are in the Western Province health services will be able
to come to the Australian health services in a mentoring and capacity building
process.[50]
4.33
According to Ms Holden, when Australian clinicians refer a patient back to
PNG, they are 'not necessarily always aware of the conditions' and capacity of
the relevant PNG health facility. The project is intended to improve that
understanding.[51]
4.34
The committee sees significant benefits in facilitating the travel of
health professionals and other relevant government officials between Torres
Strait Islands and Western Province Treaty villages. As noted, it would not
only reduce the time and cost of travel but also the risk of transmission of
communicable diseases to the islands through the treatment of patients and
diseases at their source. Now that the administrative arrangements are settled,
the committee is of the view that efforts should focus on developing and
implementing programs that can take advantage of this initiative.
Recommendation 2
4.35
The committee recommends that the Australian Government give serious
consideration to measures that would further facilitate the proposal for
greater cross-border involvement by Australian health professionals in both the
provision of services and capacity building on the PNG side of the border.
4.36
Poor communication between health professionals across the border has
been an impediment to effective provision of health care for PNG traditional
inhabitants. Evidence to the inquiry suggested that patient records have not
been communicated properly between the island health clinics and PNG health
professionals. There was also concern about the lack of a coordinated treatment
program in Western Province for those diagnosed with TB in a Torres Strait
health clinic who have returned to PNG.[52]
As noted earlier, incomplete treatment of tuberculosis may make the disease
resistant to drugs and thus become even more difficult to treat.
4.37
AusAID acknowledged that both it and DoHA are aware of the difficulties
regarding cross-border communication.[53]
Several initiatives have been established to resolve the problem. In 2006,
AusAID funded Queensland Health to trial a communications officer position on
Thursday Island to liaise with the South Fly District Health Officer on cross-border
health issues.[54]
The trial was successful and is now funded on an on-going basis on the
Australian side as part of the HIC Package of Measures.[55]
The officer's role is to transmit 'confidential patient and surveillance data
gathered in respect of PNG nationals diagnosed and treated in Torres Strait
clinics'.[56]
4.38
The Western Province Communications Officer based in Daru conducts
clinical outreach visits to aid posts and health centres to support the
follow-up and treatment of PNG nationals who have been diagnosed with
tuberculosis in the Australian health clinics.[57]
Both communications officers are medically trained doctors, and the person on
the Australian side, who is also a PNG citizen, has worked in PNG as a doctor.[58]
4.39
The House of Representatives Committee on Health and Ageing recommended that
due to their success, additional health communications officer positions should
be considered 'on both sides of the border to support the two current
positions'. It noted that because compliance is a major issue, 'it is not
realistic to expect one or two officers to monitor everything and everyone'.[59]
This committee supports the House of Representatives committee view and
recommendation and urges the government to consider additional communications
officer positions in the Torres Strait region.
4.40
Despite these initiatives, communication across the Torres Strait remains
poor. Evidence to the House of Representatives inquiry suggested that the Torres
Strait communications officer has been used 'as a carrier pigeon' who
physically takes the information across the border because 'we cannot do it
reliably by mail, fax or email'.[60]
A communication protocol is being developed to facilitate the exchange of
clinical information across the international border. This is intended to:
...enable follow-up and treatment of PNG nationals diagnosed
with TB at Torres Strait Island clinics at home in PNG. It will also aid in the
tracking and identification of PNG nationals who have been diagnosed with
MDR-TB at Torres Strait Island clinics to ensure they are followed up for
treatment within the Australian health system until such time as this capacity
is built in the Western Province.[61]
4.41
Work is also underway to implement a telephone/HF radio interface system
that will enable clinical workers on both sides of the border to converse in
real time. The system will allow calls from telephones to high frequency radios
and vice versa.[62]
Ms Jennifer Lean, AusAID, explained:
Queensland and our own programs in Western Province have
equipped them with mobiles and they basically keep tabs on who is coming
across, what are they diagnosed with, what are their treatments, how do they
get followed up on the PNG side of the border. It is a surveillance mechanism.[63]
4.42
For a similar purpose, a health services radio network has been
established, including the installation of radios at 40 sites in Western
Province, to improve health communications in the region.[64]
4.43
The H1N1 (swine flu) epidemic and closing of the Australia–PNG border in
2009 highlighted the need for effective communication. As the Queensland
Government noted, 'local clinicians on both sides of the border need to be able
to authoritatively communicate about cross-border pandemic management'.[65]
Committee view
4.44
Having identified a problem with communication technology in the region
and taken steps to fix the shortcomings, the committee is of the view that the
Australian Government should monitor the effectiveness of these measures,
taking account of the need to ensure that the improvements are sustainable.
Effectiveness of Australia's aid
4.45
The committee has not examined all projects funded by Australia and
undertaken in Western Province to improve health services. While it is clear
that Australia is not neglecting this area, a number of witnesses questioned the
effectiveness of Australia's assistance. Many of their concerns replicate those
identified by the committee in a number of previous reports on the delivery of
Australian aid. They strongly underline the importance of Australian aid
agencies ensuring that their contribution to improved health care is long term and
consolidates and builds on earlier successes.
Maintaining and supporting programs
4.46
In his submission, Mr Kevin Murphy, an anthropologist who has worked
extensively in the Torres Strait, observed that building infrastructure or
other facilities in Western Province will not be enough to reduce the pressure
on Torres Strait Island health clinics. In his view, capacity building is also
needed. He argued that 'Entrusting these things to the Western Province
administration had not been effective in the past' and used the following
example:
The person who was employed at the Buzi aid post had very
limited training and was not regarded by the people of the village as competent
to diagnose or treat anything but the most common and minor injuries.[66]
4.47
Mr Graham Smith drew on his experience with a project in the region to
provide a telling example of Australian time and money spent on a facility that
'came to nothing in the end' and 'died from starvation'.[67]
According to Mr Smith, although the South Fly Telecommunication Network was
'successfully designed, purchased, constructed and commissioned, within the
approved budget', it no longer functioned after two years. He stated:
The reasons for this are essentially that no one wanted to
maintain the network. AusAID only saw their role as providers. It was to be the
responsibility of PNG to maintain the network.[68]
4.48
On the demise of this facility, Ms Shipley noted further:
Continual problems with the operation of the network and
unattended repairs were raised at a number of Torres Strait treaty meetings,
and a core issue with the project was the failure of the government of PNG to
provide funds for maintenance and repair. During site visits to locations in
Western Province in August 2006, it was noted that no stations were using the
network because the majority of the equipment had been stolen or damaged.
AusAID was advised at the time that the network was just not operational.[69]
4.49
Also, the frequency band was no longer available for fixed or mobile
communications in Australia by the time the project was completed. Mr Smith
wanted to highlight for the committee the kind of things that the Australian Government
had tried before but the results of which 'can be seen rusting in the coastal
villages along the PNG coastline'.[70]
According to AusAID, the project was indicative of an on-going problem 'where
agreements are made and large infrastructure programs are sought', but where the
PNG Government 'does not allocate the recurrent costs necessary to maintain the
networks'.[71]
4.50
Along similar lines, Mr Kris explained that through the JAC, the TSRA has
'talked about putting infrastructure on the ground in those particular
communities to try and cater for some of those needs'. He noted that their
biggest issue 'is the security of the infrastructure on the other side of the
border and the professional people to actually operate in those remote
communities'.[72]
Councillor Pedro Stephen, Torres Shire Council, was also concerned about the
lack of attention given to maintaining infrastructure in PNG. He argued that
funding for infrastructure projects is made available but it only allows for
establishment or building costs; building capacity to maintain the facilities
is ignored:
...there is a lot of good infrastructure out there and
millions of dollars have been spent by the state to build all the health
centres, but there is no money to maintain those health centres. So you have a
health centre out there and within 12 months the screen door cannot shut
because it is frozen due to the salt content.[73]
4.51
The committee notes that the issue raised by witnesses about the need
for the government to ensure that aid funding covers both the building of a
facility and its maintenance is not new. In numerous previous reports, the
committee has identified this problem in the delivery of Australian aid programs.
Most recently, in its report on the economic challenges facing PNG and the
island states of the southwest Pacific, the committee registered its concern
that far too often, the achievements from Australia's aid program were
'short-lived and left no tangible lasting benefit'. It cited the problem of
infrastructure or equipment falling into disuse when funds and technical
assistance were withdrawn. It was of the view that:
...for aid to have an enduring positive influence on economic
and human development, policy making and planning has to go beyond the actual
period of implementation to how particular programs build on past achievements
and are a stepping stone to future progress. Consideration should be given to
aspects such [as] the capacity of the recipient country to assume
responsibility for maintaining the program, including the required level of
skills, and/or the need for recurrent funding or support from donors to ensure
that the benefits from aid programs are not lost.[74]
4.52
Importantly, the recent independent review of the PNG–Australia
Development Cooperation Treaty drove home the same messages about 'a perceived
lack of impact, and failure to obtain value-for-money' from Australia's aid
program to PNG. The authors noted that the program was so thinly spread that
its impact had become 'hard to discern'.[75]
The review team also referred to the 'historic and persistent underfunding of
recurrent expenditure in PNG', noting that 'closer links between the aid
program and the recurrent budget should be sought'.[76]
4.53
The committee notes also that its views are further supported by the House
of Representatives Standing Committee on Health and Ageing that recommended 'that
any new health facility that the Australian government helps construct should
provide for staff accommodation and ongoing maintenance, in consultation and
partnership with the local community'.[77]
4.54
AusAID acknowledged that the PNG health system remained fragile.[78]
It also noted that the effect of Australia's assistance could be stronger. Ms
Shipley stated that 'An overly cautious approach to risk management has delayed
financing for health service delivery at the required levels'. In addition, technical
assistance had not improved health systems capacity 'commensurate with the cost'.[79]
Accounting for use of funds
4.55
Earlier, the committee considered the problems that PNG has with targeting
and allocating funds effectively for health services. In the context of
allocating funds, Ms Lean informed the committee that a large amount of the
money provided through both AusAID and the Government of PNG into the
provincial treasury remained unspent.[80]
Local leaders in the Torres Strait were also concerned about the proper use of
Australian development assistance to PNG. TSRA called for 'more stringent
control of AusAID funding to the PNG Government' to ensure that funding to
develop health services reaches Western Province.[81] Mayor Gela expressed the view:
We get the feeling that the PNG government does not care
about the people of the Western Province because Australia is taking care of
them via the treaty. The Australian government needs to be tougher on the PNG
government, dictating where the foreign aid goes so that it can be directed to
the Western Province, as this area is completely neglected. Appropriate consultation
in relation to the treaty cannot be one-sided. The Western Province needs to be
consulted and not just the PNG government.[82]
4.56
Mr Kris queried AusAID's audit processes, adding:
For ever and a day Australia has been putting money into
AusAID to look at building infrastructure and to look at reducing the numbers,
but we still do not see any infrastructure on the ground. We [are] still
talking about the same recommendation 10 years after the discussion has
started...Who audits the funding that Australia gives to PNG and requires
implementation of infrastructure in these communities so that it does reduce
the number of issues that are popping up under our treaty?[83]
4.57
Mr Wayne See Kee, TSRA, recognised the need for a tighter and more
robust accountability and evaluation framework. He suggested, for example, that
with cross-border facilitated visits, there should 'be a target with these
measures now where we can start to quantify whether these things are making a
difference'.[84]
4.58
It should be noted that the committee has dealt with the importance of
monitoring and evaluating the effectiveness of Australia's aid program in
previous reports. In November 2009, the committee noted the importance of tracking
the progress of projects and assessing the extent to which achievements endure.
It emphasised the need for rigorous evaluation. In doing so, it commended the
work of the Office of Development Effectiveness but urged that it 'give greater
attention to assessing the long-term effectiveness of Australia's aid program'.[85]
4.59
A finding of the recent review of the PNG–Australia Development
Cooperation Treaty reinforced the committee's findings. The review was of the
view that 'greater use of monitoring and evaluation, existing beyond audit, would
enable AusAID to establish not only that funds had not been misused, but that
they have been used effectively'.[86]
Committee view
4.60 The committee outlined a number of initiatives established by the
Australian and Queensland governments together with the PNG Government to
address health-related concerns, including communicable diseases, staff
shortages and lack of infrastructure on PNG side. Western Province is of
strategic importance to Australia due to its proximity and, considering the
high risk of transmission of communicable diseases, the committee believes that
funds should be especially earmarked for Western Province and the South Fly
District in particular. It supports strongly Australia's efforts to build capacity
in this region but is concerned with the overall effectiveness of such measures.
The committee also believes that tighter control and monitoring should be
exercised over the way in which Australian development funding is spent in PNG.
Recommendation 3
4.61
The committee recommends that the Australian Government use the Papua
New Guinea–Australia Partnership for Development to detail the assistance it is
providing to PNG to improve the delivery of health services in the southern
part of Western Province and to ensure that projects undertaken in this region
are appropriately monitored and evaluated during implementation and after
completion.
Recommendation 4
4.62
The committee recommends that to improve accountability and transparency
of Australia's development aid spending, AusAID's Office of Development
Effectiveness (ODE) conduct an analysis of Australia's funding in relation to
Western Province in the Torres Strait region.
4.63
This analysis must provide an accurate and quantifiable account on the
effectiveness of Australian aid provided to Western Province in the Torres
Strait region. Special consideration must be given to the outcomes of
Australian Government initiatives in the region, including both technical
achievements and outputs and changes in attitudes and behaviour.
Cooperation between Queensland
Health and AusAID
4.64
A state government and two Commonwealth agencies carry the main
responsibility for health matters in the Torres Strait region, with
responsibilities divided accordingly. Queensland Health, as part of the
Queensland state government, is responsible for the provision of health
services on Torres Strait Islands. DoHA, a representative of the Australian Government,
is in charge of the coordination and administration of health services. AusAID
manages the Australian Government's aid program on the PNG side in cooperation
with the PNG and regional governments.[87]
4.65
DoHA considered the cooperation between the various agencies in the
Torres Strait to have been 'quite strong over the years', in particular in
relation to identifying issues and progressing work arising out of them. It
also noted that the Australian and Queensland government agencies cooperate
well in sharing information and working collaboratively.[88]
The Queensland Government noted that it would be beneficial for the state and
federal governments to 'work together to enhance capacity and capability by
providing training' to locals.[89]
4.66
The division of responsibilities between government agencies is
understandable and follows the usual arrangements. However, the Torres Strait
region is not a typical jurisdiction. The implementation of the provisions of
the Treaty call on the coordination of the services of the numerous state and
federal government agencies present in the region, including those responsible
for health services. The committee considers that the Torres Strait region provides
a unique opportunity for Australia and PNG agencies to work together to make
significant improvements in the standard of health services available in the
South Fly District. The region has to be considered as a whole. Therefore,
government agencies, whether state or Commonwealth, need to ensure that there
is complementarity and continuity in their work and funding across the border.
4.67
The committee is strongly of the view that projects on both sides of the
border should complement and strengthen each other. With regard to health
services, the international border provides an ideal opportunity for Queensland
Health and AusAID to form a close partnership to ensure that the region as a
whole benefits from government funding.
Recommendation 5
4.68
The committee recommends that the analysis mentioned in the previous
recommendation also look closely at the extent and effectiveness of AusAID's
cooperation with Queensland Health and consider ways to ensure that their work
in the Torres Strait region is seamless across the border and that their
operations and funding complement each other.
4.69
To this stage, the committee has considered ways to encourage PNG
nationals to seek medical assistance in their own country. The main focus has
been on pre-border measures that are designed to improve the quality and
delivery of health services in PNG so that people no longer feel the need to travel
across the border to Australian health clinics. The following chapter looks at
measures designed to discourage, even prevent, PNG nationals from crossing the
border to access Australian health services.
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