The combination of programmatic policy-based assistance and TA support provided under this initiative proved to be effective and should be continued. The lack of qualified and experienced local consultants had been a recurring issue, and the Ministry of Health (MOH), the executing agency, continued to face a shortage of sanctioned staff. By giving consultant support to key departments of MOH, the TA contributed to knowledge transfer and capacity building for these departments, and to stronger coordination across the MOH and other ministries.
Effective implementation of system reforms, given their long-term horizon, requires phased support from development partners. The multiple tranche arrangement employed by this program ensured satisfactory progression as a precondition for continued ADB assistance and strengthened the government’s accountability for the reforms.
The policy actions pursued under this program were developed in an open, participatory manner. They were fully aligned with the country’s Health Sector Reform Strategy and Health Sector Development Plan. The participatory development and full alignment of the reform program with the country sector strategy and development plan ensured strong and broad ownership and commitment from the government, and with the assistance of development partners, strengthened policy dialogue and coordination.
While the objective of this standardization was to accelerate the signing of MOAs, it had, in fact, an opposite result, i.e., with the MOA not considering the local conditions, constraints and needs at the onset, the MOAs were not always satisfactory, causing delays in signing. Sector level lessons. On the one hand, working with enclave operators and civil society organizations can, under some circumstances, be a cost-effective option to expand and improve health services delivery in rural areas. The project provided useful information on how to engage with the private sector (i.e., economic operators and not-for-profit civil society organizations, especially the churches in PNG). On the other hand, while the NDOH enthusiastically supported a partnership with the economic operators in the rural development enclaves, there appeared to have been a lack of project ownership by the local provincial and district authorities, at least at the beginning of the project. With decentralization, it is important to confirm the local governments’ representatives’ involvement in project preparation and their commitment.