It needs to be recognized that the system of administration prescribed by the OLPGLLG constitutes a major constraint on strengthening the health system. The Department of Health is limited in what it can do to impact on the health of the nation’s people, because the power to determine how much is spent on health care, and how health staff are deployed and managed, is in the hands of individual provincial governments.

From a population health point of view, Papua New Guinea has never needed an effective and functioning health system more. Papua New Guinea is on the brink of an AIDS crisis of southern African proportions (see chapter 19). Tuberculosis is reemerging as a major public health problem and is an increased risk with the escalating HIV/AIDS epidemic. Non-communicable or ‘lifestyle’ diseases are posing a substantial threat to the adult population and threaten to create a chronic burden on the health system which is already incapable of providing basic interventions for the common communicable diseases of pneumonia, malaria and immunizable diseases. Papua New Guinea has long had unacceptably high levels of maternal mortality and these continue unabated. The gravity of the situation, and the consequences of not taking steps to ensure the rebuilding of the system to a level where basic services can be delivered, cannot be over-stated. Papua New Guinea needs to determine its own policy solutions; however, any policy option must incorporate recognition of the depleted state of the health system and its key human resources. Without a strategy for rebuilding systems and human resource capacity to deliver health services, none of the policy options outlined above will succeed.