Project Name Rural Primary Health Services Delivery Project
Project Number 41509-013
Country Papua New Guinea
Project Status Approved
Project Type / Modality of Assistance Loan
Source of Funding / Amount
Grant 0259-PNG: Rural Primary Health Services Delivery Project
Australian Grant US$ 40.00 million
Grant: Rural Primary Health Services Delivery Project
World Health Organization US$ 1.00 million
Japan International Cooperation Agency US$ 1.20 million
Loan 2785-PNG: Rural Primary Health Services Delivery Project
Asian Development Fund US$ 20.00 million
Loan 8274-PNG: Rural Primary Health Services Delivery Project
OPEC Fund for International Development US$ 9.00 million
Strategic Agendas Inclusive economic growth
Drivers of Change Governance and capacity development
Sector / Subsector Health - Health sector development and reform
Gender Equity and Mainstreaming Gender equity
Description The project will strengthen rural health systems in selected areas by expanding the coverage and improving the quality of primary health care in partnership with state and other service providers. It will build on Asian Development Bank experience in strengthening health service delivery in rural areas of PNG. The project will cover two districts in each of the following eight provinces: Eastern Highlands, East Sepik, Enga, Milne Bay, Western Highlands, West New Britain, Morobe, and the Autonomous Region of Bougainville.
Project Rationale and Linkage to Country/Regional Strategy

The government's long-term Vision 2050; Development Strategic Plan, 2010-2030; and Medium Term Development Plan, 2011-2015 aim to transform PNG's health system to achieve the Millennium Development Goals for health and improve PNG's ranking in the human development index. In support of the government's approach and in line with ADB' operational plan for health, ADB's country partnership strategy for PNG, 2011-2015, which recognizes issues of fragility in PNG, includes health as a priority area.

The health status of the population of PNG has deteriorated since 1980s with severe neglect of the health system, especially in rural areas, where 87% of the population lives. An estimated 40% of rural health facilities have closed or are not fully functioning. Limited resources, deteriorating infrastructure, poorly trained staff, and inadequate and declining access to basic health services are among the main reasons for the decline.

The country has widespread poverty and weak health indicators, particularly for maternal and child health. The infant mortality rate is 57 per 1,000 live births and the maternal mortality rate is 733 per 100,000 live births. The main health problems continue to be communicable diseases, with malaria, tuberculosis, diarrheal diseases, and acute respiratory disease being the major causes of morbidity and mortality. PNG has a generalized HIV epidemic, driven predominantly by heterosexual intercourse. The epidemiological profile of PNG, with a heavy burden of communicable disease, indicates that significant gains in health outcomes could be achieved with simple and effective interventions focused on PHC and health promotion. While some hospital services (e.g., for maternal complications) are essential, more than 80% of health problems can be addressed adequately and at lower cost through the effective delivery of PHC. The current poor health status of the rural population points to a weak PHC system that lacks outreach services such as for child immunization and providing women with the basic support required for safe delivery.

Provinces and districts are responsible for delivering health care services through hospitals, health centers, health subcenters, community health post (CHP), and aid posts. The 1998 Organic Law on provincial and local-level governments significantly decentralized responsibility for delivering health care services to the provinces and districts. However, the law did not adequately address how to implement the changes. In the health sector, only operational responsibilities have been devolved, while capital investments remain centralized in the public investment program. Provinces are allocated a percentage of net government revenue through staffing and health sector functional grants, which cover operational costs but not capital investment costs. Resources, authority, and competency are thus poorly aligned with decentralized responsibility.

To overcome this misalignment, three provinces have so far exercised the option outlined in the 2007 Provincial Health Authorities Act to establish their own provincial health authorities. In addition, the government, recognizing that it needs to prioritize health service delivery in districts and communities, has recently developed the concept of the CHP in 2010. CHPs will provide services at the outer perimeter of the health system. Over time, the government will transform existing aid posts and health sub-centers into a service able to meet the requirements of the National Health Plan (NHP) 2011-2020.

ADB has provided support for the PNG health sector since the 1980s. The completed Health Sector Development Program10 established the Health Sector Improvement Program (HSIP) trust account in 1998, which became a major mechanism for administering extended development assistance to the health sector.

The HIV/AIDS Prevention and Control in Rural Development Enclaves Project has successfully built innovative partnerships with non-state service providers to improve rural PHC service delivery. Under that project, local health authorities in eight provinces established partnerships with six large private companies to improve more than 100 rural health facilities and trained health workers and communities in preventing HIV/AIDS transmission, significantly increasing the number of PHC beneficiaries in project areas.

Building on the lessons and experience of the existing project, the proposed project will support the government in implementing NHP, as it relates to rural health. The project will establish and develop partnerships between state and other health care service providers, including the private sector, churches, nongovernment organizations, and civil society, working at the provincial and district level to strengthen the rural PHC system.

By working through the envisioned partnerships, the project will build human resource capacity in the health sector, improve health information and monitoring systems, and revitalize rural health facilities to strengthen the existing rural PHC system in PNG. The project will expand the coverage and improve the quality of PHC services for the rural population by strengthening the rural health system at the provincial and district level.

The project will be implemented under the sector-wide approach currently in place for the health sector. To avoid replicating government functions, the project will use government systems whenever possible, and the government will be responsible for all facility recurrent costs. The project will focus on infrastructure and training that can help the government deliver health services more efficiently and effectively, building on the strengths of existing health institutions run by the government and others.

Impact Improved health of rural population in the project areas.
Project Outcome
Description of Outcome Selected provinces in partnership with non-state service providers, efficiently deliver high quality PHC to rural residents, in particular to women and children
Progress Toward Outcome Partnerships among health service providers have been established in each of the project province. Project activities are being implemented to strengthen health workers capacity and build CHPs to provide quality primary health care. Local health promotion is being implemented to change health behavior of the communities.
Implementation Progress
Description of Project Outputs

1. National, and selected provincial and district governments implement policies and standards for community health posts

2. Sustainable partnership established between selected provincial governments and non-state actors for delivering PHC services

3. Community health workers in project areas have the capacity to provide quality PHC services

4. Selected provincial and district governments upgraded selected rural health facilities.

5. Local communities in project areas are aware of maternal and child health, HIV, sanitation and gender issues

6. Effective project monitoring, evaluation and management services rendered

Status of Implementation Progress (Outputs, Activities, and Issues)

The progress of the project are as follows:

Output 1:

- Project achieved one of the major outputs i.e. Community Health Post Policy and Implementation Guidelines completed, approved and disseminated

- Ongoing activities include support to health human resource strengthening and implementation of the national health information system

- Extended support in assisting the provinces to develop their Health Services Development Plan to guide their health infrastructure investment and service planning.

Output 2:

- Partnership committees established in all project provinces. These committees will be institutionalized in Provincial Health Authority provinces

- Ongoing support to strengthen the partnership committees through follow-up visits by the project and assistance by the health mentor

- The partnership committees also serve as a channel to solicit health promotion and staff training proposals from both public and private health service providers (under component 5).

Output 3:

- Trainings of rural health staff in project provinces under the DFAT funded Reproductive Health Training Unit i.e. Emergency Obstetric Care and Essential Obstetric care courses completed in most of the provinces.

- Preparatory work and pilot of: Training of Clinical Preceptors for Project Province Public Hospitals; Integrated Management of Childhood Illnesses; Rural Health Facility Management Training Course completed.

- Autonomous Region of Bougainville received trainings on National Health Service Standards in collaboration with DFAT-funded HHSIP.

Output 4:

- The first civil works in Milne Bay is ongoing. Next sites are: Yasubi in Eastern Highlands and Alkena in Western Highlands (all government or church-owned lands) while the other sites are under preparation and subject to the finalization of the land alienation process and building board approval.

- 29 out of 32 communities have been consulted as part of the requirements for the civil works preparation; agreement has been reached with customary landowners of 24 out of 27 sites.

Output 5:

- First round of community consultation completed in almost all the project sites (except those with land related community disputes) which will pave the way for promotion of maternal and child health, gender equity, prevention of gender based violence, HIV awareness and testing and other identified needs.

- Scope of future assistance will include producing health promotion activity plans on Healthy Island concept and rolling-out of trainings and capacity building support

- Other ongoing support include: updating of the community action and participation materials, revision of the Village Health Volunteer curriculum and

- Gender and health activities include: support to Family and Sexual Violence (FSV) Guidelines and training curriculum for health professionals to respond to FSV; gender and health updates to partnership committees; support to deliver trainings on STI, HIV, Family Planning (i.e. with Milne Bay School of Nursing, health staff in Western Highlands and Enga Provinces).

Output 6:

- Formative evaluation has been engaged for a year now

- Baseline studies completed in all 8 provinces

- Small-scale research planned on (i) women's health seeking behavior and (ii) relations between high levels of primary health care and improved health status/better health outcomes

Geographical Location
Safeguard Categories
Environment B
Involuntary Resettlement C
Indigenous Peoples C
Summary of Environmental and Social Aspects
Environmental Aspects The Project is classified as category B in accordance with ADB's Safeguard Policy Statement (2009). An environmental assessment and review framework is being prepared to guide the assessment and review process for project investments. These investments, which will be dispersed in 16 rural districts, are expected to be small-scale and replicable in nature. Once sites are selected, specific details on how to mitigate and monitor effects are provided in the Project's initial environmental assessment. The DOH and the Department of Environment and Conservation will clear the framework and examination in accordance with their rules and procedures.
Involuntary Resettlement The Project is not expected to involve land acquisition or involuntary resettlement. All civil works will be undertaken on land currently being used by existing health facilities. A land assessment framework has been prepared that provides detailed guidelines about assessing and confirming the land proposed for each health facility is state-owned or is owned by a health services partner organization (e.g. a church) with control over the operations of such existing facility.
Indigenous Peoples Melanesians comprise the vast majority of the PNG population. The Project is not expected to have any negative impact on indigenous peoples. While a separate indigenous peoples plan is not needed, all project outputs will be delivered in a culturally appropriate and participatory manner to meet the needs of various people of the country.
Stakeholder Communication, Participation, and Consultation
During Project Design The National Department of Health (NDOH) is the executing agency responsible for managing and supervising all project activities. NDOH will also coordinate with other Government departments at the national and provincial level, with donor partners and relevant stakeholders in implementing the project. The PMU was established under the NDOH and support the NDOH in project management including procurement of goods and services. Method of consultant recruitment for firms and individual will be the quality and cost-based selection and simplified technical proposals.
During Project Implementation

NDOH will provide all critical and important information to various stakeholders in a manner easily understood by them. Special efforts will be made to provide information to the citizens and proper compliance will be ensured with national legislation on rights to information.

Provinces will be supported to conduct information campaigns on community health posts and strengthening the PNG rural health service delivery system to keep the public and staff engaged and informed. Public disclosure of all project documents will be made available through the development of a Project website attached to the NDOH website. The PSU manager under the signature of the DOH will produce a short newsletter every two months to inform stakeholders of the progress being made by the project. Formative evaluation reports will be disseminated widely, including to other provinces with an interest in health system strengthening. Annual PNG health sector national conferences will be used to keep the staff of the health service and the public fully informed of developments and progress.

Special efforts will be made to provide information to the citizens and proper compliance will be ensured with national legislation on rights to information.

Business Opportunities
Consulting Services An estimated 1,756 consulting months will be required to successfully implement the project. The majority of consulting services will be recruited using the quality cost based selection approach, adopting a cost quality ratio of 80:20. Where limited skills are available in the local market or where the quality of the services is of overriding importance to the outcome of the project, a quality based selection approach may be adopted for the recruitment of national consultants. At the request of the government and to assist the facilitation of project start-up the ADB will assist with the recruitment of the international project manager. A professional services firm may be engaged to fulfill some administrative activities performed the PSU.
Procurement All procurement of goods and works will be undertaken in accordance with ADB's Procurement Guidelines. Project civil works are small and relate to construction, rehabilitation and upgrade of existing facilities. No land acquisition will be necessary.
Responsible ADB Officer Ninebeth Carandang
Responsible ADB Department Pacific Department
Responsible ADB Division Urban, Social Development & Public Management Division, PARD
Executing Agencies
Department of HealthADB Projects Office, P.O. Box 807,
Waigani, NCD,
Papua New Guinea
Concept Clearance 17 Nov 2011
Fact Finding 19 Nov 2010 to 28 Nov 2010
MRM 16 Feb 2011
Approval 30 Sep 2011
Last Review Mission -
Last PDS Update 25 Feb 2015


Financing Plan Grant Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 2.20 Cumulative Contract Awards
ADB 0.00 - 0.00 0.00 %
Counterpart 0.00 Cumulative Disbursements
Cofinancing 2.20 - 0.00 0.00 %

Grant 0259-PNG

Approval Signing Date Effectivity Date Closing
Original Revised Actual
30 Sep 2011 15 Mar 2012 18 Jun 2012 30 Apr 2020 - -
Financing Plan Grant Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 42.20 Cumulative Contract Awards
ADB 0.00 30 Sep 2011 0.00 15.03 38%
Counterpart 0.00 Cumulative Disbursements
Cofinancing 42.20 30 Sep 2011 0.00 7.43 19%

Loan 2785-PNG

Approval Signing Date Effectivity Date Closing
Original Revised Actual
30 Sep 2011 15 Mar 2012 18 Jun 2012 30 Apr 2020 - -
Financing Plan Loan Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 30.00 Cumulative Contract Awards
ADB 20.00 30 Sep 2011 10.85 0.00 61%
Counterpart 10.00 Cumulative Disbursements
Cofinancing 0.00 30 Sep 2011 6.14 0.00 35%
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating - Satisfactory - - - Satisfactory

Loan 8274-PNG

Approval Signing Date Effectivity Date Closing
Original Revised Actual
21 Dec 2011 29 Jan 2013 16 Oct 2013 28 Feb 2017 - -
Financing Plan Loan Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 9.00 Cumulative Contract Awards
ADB 0.00 21 Dec 2011 0.00 0.00 0%
Counterpart 0.00 Cumulative Disbursements
Cofinancing 9.00 21 Dec 2011 0.00 0.00 0%
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating - Satisfactory - - - Satisfactory

This project data sheet was generated from on 02 September 2015