Several important developments have taken place since this paper was written. These include the passing of the Provincial Health Authorities Act (2007), amendments to inter-governmental financial arrangements (2008), the delegation of powers from Department of Personnel Management to line agencies, and the establishment of a Public Private Partnership Taskforce and development of a draft National Public Private Partnership Policy (2008).

The Provincial Health Authorities Act was passed in May 2007. The purpose of the new law is to enable provinces to create provincial health authorities to deliver both public health services and curative services. The initial roll-out will take place in three provinces in 2009. Further work is underway with the Department of Treasury to develop the new financial arrangements necessary to bring together hospital funding from the national government and provincial funds for public and rural health service delivery, and with the Department of Personnel Management to establish management and staffing structures for the provincial health authorities.

In July 2008, the National Parliament approved important changes to the intergovernmental financial arrangements, aimed at strengthening the delivery of basic services by provincial governments. The new system is intended to ensure the flow of funding to key service sectors operating at district level, including health facilities and integrated health patrols. Service delivery priorities are reflected in a set of minimum priority activities approved by an interdepartmental committee responsible for overseeing the implementation of the new system. During 2009, implementation indicators will be developed to enable provincial administrations to monitor and report on both achievements in implementation of programs as well as spending of budgeted funds. The Department of Provincial and Local Government Affairs will be looking at some instances of provincial and local-level funding and service delivery, including specific attention to the funding of rural health centres and aidposts.

In April 2008, the government signed a MoU with the Asian Development Bank (ADB) for Technical Assistance to develop a national public private partnership policy for Papua New Guinea; a draft public-private partnership policy was completed in August 2008. The Department of Health has requested technical assistance from the ADB to develop the capacity to facilitate and monitor public-private partnerships for the health sector.

These developments have the potential to improve implementation of health services to the rural population and to facilitate the development of a differentiated approach to health service delivery in Papua New Guinea on a province-by-province basis. However, whatever the organizational arrangements, sufficient skilled human resources and equipment will still be required to ensure that the Papua New Guinea Minimum Standards for Rural Health Services are provided. This will require the mobilization and organization of resources from national and provincial governments, and donors.