Decentralization of health services in Western Highlands Province, Papua New Guinea: an attempt to administer health service at the subdistrict level.

In 1990, Western Highlands Province in Papua New Guinea, decentralized the administration of health services from the province (population 264,000) to 14 districts (equivalent to subdistricts elsewhere). Two years later interviews were conducted with health workers and district and provincial heads. Productivity data were obtained from the provincial health information system and financial data from the provincial and national budgetary report. Health workers had a predominately negative opinion of the results of the decentralization. The most common complaints listed were lack of qualifications of District Assistant Secretaries, a diversion of funds to other programs, unavailability of transportation, a lack of equity in personnel between districts and a lack of adequate professional supervision. The problems which developed in this attempt at further decentralization related to a lack of professional support and oversight of health professionals, a lack of role definition for provincial and district administrators, lack of management training for district officials, inadequate oversight by local elected officials and inadequate budgets.