Tuesday, April 28, 2009


Martyn Namorong





There have been various media reports and commentaries on the issue of Free Education. I wish to support advocates of free education for all and I propose that we take this issue a step further by constitutionally establishing access to quality Primary Education as a fundamental social right. In doing so, we make the government obliged to provide education for all thus achieving one of the Millennium Development Goals (MDGs). Also, the constitutional guarantee to education prevents any political entity from using free education as a campaign gimmick.

By the same token I’d like to see that there be constitutionally recognized right to Universal (free) Primary Health Care. Primary Health care is the “first contact” place or person one encounters when seeking medical assistance. It may be at school, from traditional healers etc… but for the purpose of this discussion I’ll refer to places such as clinics, health centers and outpatients departments of hospitals.

While I do understand that the Public Health system is heavily subsidized, I believe there should not be any monetary barrier to accessing proper health care. Our society already has barriers to accessing healthcare put up by custom, stigmatization, tough terrain and lack of education and the last thing we need is a financial barrier.

Now, the skeptics may say that this is absurd and that we cann’t afford such a system. Oh but YES WE CAN. ‘Wealth and Health’ is neither sufficient nor necessary i.e generating wealth is not a precondition for generating health. The Cuban health system demonstrates to us that it is possible to have first world health statistics from a third world economic base. Cuba has GDP per capita of US$ 3 438 and life expectancy of 78 years and under 5 mortality of 7:100000 compared to the United States, which has GDP per capita of US$ 37 572 and the same figures in relation to life expectancy (78 years) and under 5 mortality (8:100000).

Of course solving the health problems is not as simple as removing user pay fees. Our health systems are weak because of decades of neglect of basic health infrastructures, services and staff. We all know of examples including, termites eating up hospital buildings, of pharmaceuticals and condoms not being delivered and of Sisters (and Resident Medical Officers) not being paid their dues on time. And all this is happening in the shadow of Global pandemics (like HIV) and the emergence of multi-drug resistant infectious diseases.

According to Margaret Chan (Director of WHO), with the support of institutions and organizations such as the World Health Organization (WHO), Global Fund Against Malaria TB and HIV, and various non state actors we have at our disposal resources to acquire “powerful interventions, from excellent vaccines and medicines to long-lasting bed nets, for reaching the health-related Millennium Development Goals (MDGs). What we lack are the systems for delivering these interventions to those in greatest need”. She noted further that “primary health care tackles the root causes of ill health, including in non-health sectors, and offers an upstream attack on threats to health”.

In fact, studies have considered Primary health to be ‘‘the best route to universal access, the best way to ensure sustainable improvements in health outcomes and the best guarantee that access to care will be fair.’’ It is also an enabling mechanism for equal distribution of National wealth through equitable distribution of health care and it promotes physical well being which in turn increases human productivity.

If we are to have Universal primary health care, it must be people-centered with equal emphasis on preventive as well as curative health services. With many communities isolated by difficult terrain the greatest challenge is to bring health services to their doorstep as opposed to the notion of expecting sick people to travel great distances to get assistance. It is little wonder therefore that as a result most people present at a health settings when the disease has progressed to an advanced stage. This is unethical.

I began by discussing free education because I believe that the primary health care system should work with other non-medical determinants of health and be a key part of the processes and mechanisms of social interventions through which non-medical determinants of health [such as spiritual, emotional and socio-economic well being] can be addressed. In order that this be possible there need to be more personnel trained in both the medical and non-medical aspects of health, with more responsibility and institutionalized access to political authority.

Realistically however, based on the current trends, the future health prospects of this nation are bleak. It is highly unlikely that we may achieve any of the health related MDGs. We will still have high infant and maternal mortality rates and many people will continue to die from preventable and curable diseases. In Cuba they have achieved such wonderful health indicators because of the conscious political will and the revolutionary spirit of the people trained to carry it out. In PNG we have achieved our terrible health indicators due to the lack of political will and the incompetence/lack of capacity of trained people. What we need is constitutionally guaranteed community orientated primary healthcare that is accessible to all. Perhaps this is the way forward in the next health plan for 2011-2020.