The primacy of politics: charting the governance of the Papua New Guinea health system since independence.

To chart the course of health governance in Papua New Guinea (PNG) since Independence, this article identifies two arks of public sector administration in PNG. Each was instigated by the passing of an Organic Law. The reform periods presaged by the Organic Law on Provincial Government 1976 (OLPG) and the Organic Law on Provincial Governments and Local-level Governments 1995 (OLPGLLG) have fundamentally transformed the political and administrative structures governing the country, and in particularly those relating to health. Comparing the organization of the government-operated health system during each of these reform periods not only reveals why PNG's health services have struggled to improve since Independence, but also casts light on the key drivers of fundamental reforms in PNG. Ultimately, the exercise illustrates the 'primacy of politics', and why political concerns invariably trump service delivery concerns.