Bridging Healthcare Partnerships and Alliances in PNG; Not so Easy
I was overwhelmed with mixed emotions prior to leaving my home state of Connecticut to travel to Papua New Guinea (PNG) to share my scientific background in clinical research and pharmacology with my bedside advanced practice nursing skills as an Adult Nurse Practitioner with FHI360 (formerly Family Health International). I was happy and sad, excited and anxious, and a tad bit nervous about the impending trip. As soon as I arrived, I learned quickly that local folks refer to PNG as the “land of the unexpected/mysteries”.
For the past two months, I have been providing regular technical mentorship and capacity building to staff of the local community health centers and clinics supported by FHI360 in Port Moresby and Madang. So far, I have been involved in primary healthcare screenings, sexual health screenings, diagnostic and physical examinations, medical/pharmaceutical management, as well as guidance counseling to the clinicians who are doing them. I have been assessing, understanding, providing rationales, issuing recommendations, assisting in interventions, and analyzing outcomes.
FHI360 determined early on that one of my primary objectives should be to form alliances and bridge partnerships between healthcare service providers and strengthen the current healthcare infrastructure. For example, as stigma and discrimination against HIV+ patients is a big healthcare problem in PNG, it is of utmost importance to build professional partnership and relationship in the form of desensitization, referrals, and linkages between local community health centers and tertiary healthcare service providers like Port Moresby General Hospital. It will prove to be beneficial to all the acutely ill HIV+ clinic patients to receive timely care and treatment from the local community hospital. Without the coordinated referral system and desensitization, HIV+ patients will most likely not receive the care that they need in a timely manner. FHI360’s long-term goal is to have desensitized healthcare service providers as well as solid and sustainable referral processes to ensure programmatic continuity.
Building partnerships and alliances between healthcare service providers is at the core of the healthcare model “Continuum of Prevention to Care and Treatment” or CoPCT and is one of FHI360’s major achievements in PNG. This is a model that is specific to PNG. In this model, a coordinated approach to providing the full range of prevention, care, support, and treatment needs to those infected and affected by HIV is ensured. Continuity of care and services, through referrals and linkages, take place primarily from home, to secondary healthcare clinics and centers, to tertiary care hospitals, and back again to the primary home-based care. My role is specific to the referrals and linkages between the secondary and tertiary care centers.
Based on my own observations, like any other program, though CoPCT is a successful model that offers broad range of healthcare services, challenges are also ubiquitous. First, there is profound shortage and limitations in professional human resources (physicians and nurses) at health facilities. I went with the clinic nurse once to Port Moresby General Hospital to admit an acutely ill HIV+ and TB patient to the emergency room. The scene was of utter chaos – throngs of patients waiting to be seen and only a handful of nurses and physicians around. Second, capacity and technical competence is weak. There is great need for clinic staff supervision and technical advisement in terms of physical examination, diagnosis, communication, and laboratory testing. Reagents and medications stock-outs are frequent occurrences at the local community health centers. Third, even though systems and procedures are in place, monitoring and evaluation system is also weak. The need is also great for technical support and advisement on data mining and statistical understanding to translate results and apply them to clinical practice. Fourth, stigma and discrimination, though gradually decreasing, is still a problem in PNG, despite coordinated efforts of non-governmental organizations (NGOs) like FHI360 in desensitization. There are many other challenges as well, but, these can be viewed as opportunities for improvement. So as much as possible, I support the efforts in desensitization as well as building partnerships and collaborations between the healthcare service providers to fine tune services and improve patient outcomes.