In May 2025, the World Health Organization (WHO) announced that trachoma had been eliminated in Papua New Guinea. Trachoma is an eye infection caused by the bacterium Chlamydia trachomatis, and repeated infection can lead to blindness. This news marks progress on public health issues in Papua New Guinea.

At the same time, also in May 2025, the WHO declared an outbreak of polio in Papua New Guinea. Caused by infection with the poliovirus, severe cases can result in death due to respiratory paralysis. Polio, which was said to have been eliminated in Papua New Guinea in 2018, has re-emerged.

Addressing all infectious diseases and other health problems requires comprehensive and sustained efforts. As the two contrasting pieces of news above show, Papua New Guinea is making certain gains while still facing many public health and healthcare challenges. This article explores the history of public health issues and health policy in Papua New Guinea, the current system, and the challenges it faces.

A consultation at a general hospital, Port Moresby (Photo: Ness Kerson/madNESS Photography for AusAID / Wikimedia Commons [CC BY-SA 4.0])

Geographic and historical background

Papua New Guinea consists of the eastern half of the island of New Guinea, which borders Indonesia, as well as many islands including New Britain, New Ireland, and Bougainville. The island of New Guinea is dominated by rugged and complex mountain ranges, much of it covered by jungle. The country is rich in volcanoes and mineral resources, and coral reefs spread around the coasts. Because terrain such as mountain ranges and jungles has led to many isolated villages, unique languages developed in each area, and the country is known as having the most languages in the world.

As of 2024, the population is roughly 10 million and increasing year by year. One notable point about its distribution is the relatively low urbanization rate. As of 2024, the population living in urban areas was about 14% of the total. The age structure is very young, with children aged 0–14 accounting for 35.0% and those aged 15–24 accounting for 19.7% as of 2024. This situation directly affects challenges in education, public health, and healthcare access, with numerous implications.

Here, let’s briefly touch on the history of Papua New Guinea. The history of the island of New Guinea begins around 50,000 BCE, when humans first settled there. From around 7,000 BCE, distinct agriculture developed mainly in the highlands, and from about 2,500 years ago, people on the coasts are believed to have lived by making pottery, raising pigs, and using unique fishing techniques. Trade also took place between the islands.

In the early 16th century, voyagers from Europe reached the island of New Guinea and gradually expanded their presence. In 1884, full-scale colonization began. The northern half of what is now Papua New Guinea came under German rule as “German New Guinea,” while the southern coastal area (known as Papua) and nearby islands were controlled by Britain as “British New Guinea” (Note 1). Subsequently, these territories came under Australian administration in 1914 and 1906, respectively. During World War II, the area was occupied by Japan, but after Japan’s surrender, Papua and New Guinea were unified between 1945 and 1946 and placed under Australian trusteeship as Papua New Guinea. Papua New Guinea became an independent nation in 1975.

Today, Papua New Guinea’s economy is heavily dependent on natural resources. The largest domestic industry is mining, with significant exports of gold, copper, and oil. Fishing is also active, and tuna in particular represents an important portion of national exports. Using tropical rainforests, timber such as logs is also one of the main exports, though there are concerns about overlogging. GDP per capita in 2024 was USD 2,572, a low level, and there are severe income disparities within the country. Many people live in poverty, and when poverty is measured by the “ethical poverty line” (Note 2), the share of people living below this line reached 90% of the population in 2009.

Formation of the health care system

Before colonization, traditional medicine in Papua New Guinea was unique to each community. Many relied on herbal remedies and rituals, and in some regions, healers’ knowledge and techniques were used to treat illnesses and injuries.

During German and British colonial periods, healthcare was mainly provided by missionary groups and colonial authorities. This laid the foundation for modern medicine in Papua New Guinea. They also established medical facilities such as hospitals and clinics, but these mostly served colonial bureaucrats, missionaries, and settlers. After World War I, the Australian government, which took over administration, advanced the organization of the health system under a centralized structure. During this period, missionary groups cooperated with local administrators, setting up bases known as “mission stations,” which included public health facilities to provide health services. After the founding of the WHO, large-scale, vertical international programs such as the Global Malaria Eradication Programme were carried out.

After independence in 1975, Papua New Guinea began building its own health system. Initially, it operated under a centralized model, with the National Department of Health (NDoH) responsible for all aspects including budget allocation, workforce placement, and medicines management. Changes from the pre-independence period included establishing health centers in local areas and training health workers to expand services to more people.

However, this model has been assessed as inefficient given the country’s geographic diversity and dispersed population, and it lacked flexibility due to limited discretion at the frontline. As noted earlier, geographic factors such as mountain ranges and jungles, along with the presence of multiple isolated communities, are major obstacles to delivering health services in Papua New Guinea. Geographic constraints and population dispersion have hindered infrastructure development and secure access to healthcare.

The rugged mountains of Papua New Guinea (Photo: Alan & Flora Botting / Wikimedia Commons [CC BY-SA 2.0])

In response, the 1977 Organic Law on Provincial Government, a foundational law on local autonomy, was enacted, marking the first step toward decentralization. However, this resulted in thinly spreading personnel and resources across provinces and complicated service delivery mechanisms. A 1995 revision delegated responsibility for service delivery and budget management to provincial and local governments, while strengthening the NDoH’s roles in policy-making, setting standards, and monitoring and evaluation. As a result, provincial administrations gained greater autonomy in budgeting and human resources management, but because resources were allocated uniformly and on a fixed-rate basis regardless of need, regional disparities in health services widened.

An overview of the current health system

Let’s look in detail at the health care system currently in operation in Papua New Guinea. As noted, the country has delegated most health service delivery to provincial governments, building a decentralized health system. This has been in place since the enactment of the Organic Law on Provincial Government in 1977 and its revision in 1995.

Here, we explain the Health Sector Improvement Program (HSIP) as a response to fiscal challenges in health care. HSIP is a mechanism in which funds from the Papua New Guinea government and donors are pooled into a trust account managed by the NDoH and shared with provincial governments and supporting organizations. Originally established in 1996 with Asian Development Bank (ADB) support, the trust account expanded in 2003 with multiple donors joining, taking on an important role as a mechanism for efficiently allocating resources to improve access to healthcare, particularly in rural and impoverished areas. The funding composition of HSIP is approximately 70% from the Papua New Guinea government and about 8% from Australia’s Department of Foreign Affairs and Trade (DFAT), with the UN, New Zealand, and others participating as donors. Although HSIP has faced issues such as procedural delays and a temporary freeze of DFAT funding (2016–2018), it has improved fiscal challenges related to health services to some extent.

Medical facilities in Papua New Guinea are designed according to a clear hierarchical structure. Specifically, they are divided into seven levels, as shown in the diagram below.

At the most basic Level 1 aid post, simple procedures and infection management are provided for around 1,000 local residents. As the level rises and the target population increases, functions become more advanced, with nurses and doctors on site and capabilities for deliveries, inpatient treatment, and surgery. At the top, Level 7 includes national hospitals that provide advanced specialist care as well as medical education and research.

On paper, a “referral system” is in place to refer cases that cannot be managed at lower-level facilities up to higher-level facilities, but in practice it often becomes dysfunctional due to factors such as transportation access, shortages of personnel and medicines. In mountainous areas and on remote islands, high-urgency cases may not be managed in time. Many lower-level facilities also show inadequate or aging infrastructure, with significant equipment limitations. In addition, especially at lower-level facilities in rural areas, the influence of non-governmental actors such as churches still remains. While they make major contributions by complementing public services, integrating them into the system to ensure uniform standards of care is needed.

As in many other countries, the COVID-19 pandemic that began in 2020 exposed the fragility of Papua New Guinea’s health system. Already hampered by weak infrastructure and chronic shortages of health resources, the country saw severe dysfunction in primary and secondary care during the pandemic. This was particularly pronounced in rural areas, where health services were suspended. As a result, prevention and treatment activities for other infectious diseases such as malaria, tuberculosis, and HIV were halted, causing significant harm. Furthermore, movement restrictions and tightened border controls to prevent spread interfered with the transport of medicines and medical equipment, further worsening access to care. In urban areas, the diversion of personnel and resources to COVID-19 response led to interruptions in routine care, vaccinations, and maternal and child health programs, causing patients with chronic diseases and infectious diseases to lose access to treatment.

However, one major barrier was that key medicines such as vaccines were purchased in bulk by high-income countries, delaying Papua New Guinea’s access. The international disparities in medical access revealed during the pandemic highlighted severe global inequalities.

The coastal town of Tufi, on the island of New Guinea (Photo: Larry V. Dumlao / Wikimedia Commons [CC BY-SA 4.0])

Key health indicators and health challenges

So, what health challenges does Papua New Guinea face today? Let’s look at a few indicators.

Life expectancy in 2023 was 63.7 years for men and 66.1 years for women. Changes over the past decade or so have been small, remaining nearly flat.

Maternal and child health indicators in Papua New Guinea are in a difficult state. The infant mortality rate was 35.7 per 1,000 in 2024 and is declining year by year. However, considering that the global average (2020) was 27.4, the rate remains high. In 2023, only 5% of health facilities were equipped to provide 24/7 emergency obstetric care, and just 45% of women delivered in a health facility. Such conditions pose serious obstacles to maintaining maternal and child health.

Infectious diseases remain central to Papua New Guinea’s health challenges. Malaria and tuberculosis cases remain high, and such infections are among the leading causes of hospitalization and death. New malaria infections in 2023 exceeded 830,000. Newly notified tuberculosis cases in 2023 alone reached 38,000. Regarding HIV, new infections in 2024 numbered 11,000, with a high rate of mother-to-child transmission. Looking at vaccine coverage for various infectious diseases, as of 2024, coverage for measles and the pentavalent vaccine (Note 3) remained at 40%. Considering that coverage is 94% in Fiji and 60% in the Solomon Islands, it is markedly low.

The problem is not only infectious diseases. The rise of non-communicable diseases (NCDs) and lifestyle-related diseases—such as cancer, diabetes, stroke, and other cardiovascular diseases—also deserves attention. A 2008 survey reported that about 99.6% of the population was at moderate to high risk, and 77.7% at particularly high risk. Major risk factors include insufficient vegetable intake (87.2%), tobacco use (44%), betel nut chewing (79%) (Note 4), excessive alcohol consumption (31%), and obesity (31%). According to a 2022 report, 47% of all deaths were due to NCDs. Responding to these chronic diseases has become a new challenge.

A newborn, a mother, and a community health worker, Bougainville (Photo: Department of Foreign Affairs and Trade / Wikimedia Commons [CC BY 2.0])

Another feature of the COVID-19 pandemic was a sharp increase in deaths at home. Due to systemic flaws such as poor access, some severely ill patients could not reach hospitals, and there were also cases reported in which patients were driven out of their homes by family or neighbors fearing infection, or confined to rooms and unable to receive appropriate hospital treatment. One contributing factor was the lack of sufficient information about the disease, highlighting the need for information dissemination and community education.

Recent reforms and signs of hope

While Papua New Guinea’s healthcare and public health face numerous challenges, new initiatives have recently been undertaken to realize sustainable and inclusive healthcare. The new health promotion plan covering 2021 to 2030 reflects the commitment to the Sustainable Development Goals (SDGs) and pledges to “leave no one behind,” aiming to improve the health of the entire population and strengthen the health system. The plan places particular emphasis on developing human resources and IT infrastructure, and on data collection and use, working to improve the quality and efficiency of health information systems.

To build a sustainable health system, a “Back to Basics” approach is being pursued. Recognizing the limits of uniform, centralized service delivery due to the presence of remote islands and diverse ethnic composition, this approach focuses on primary care at the local level. While the direction is similar to the reforms of the 1990s, it incorporates the following new elements in light of challenges such as underdeveloped infrastructure, and shortages in the allocation of funds and personnel.

First, it prioritizes strengthening primary care centers and community health posts in rural areas where medical shortages are severe, so they can provide 24/7 basic medical and preventive care. This includes upskilling health staff, reinforcing the deployment of health workers, improving systems for transporting and maintaining medical equipment, and ultimately building a “healthcare pyramid” that supports smooth linkages to secondary and tertiary care. Second, it reassesses resource allocation, including HSIP funds, by making strategic investments, especially in hard-to-reach areas, based on multiple indicators such as population, infant mortality, and fiscal capacity. Third, it establishes a clear framework that positions church-based medical institutions and NGOs as institutional “partners,” not merely “complements” as they were until the 1990s, and sets a direction for integrating them into the system. Connection to the health information system is also included.

An outreach clinic using an emergency boat by tuberculosis specialists (Photo: Department of Foreign Affairs and Trade / Wikimedia Commons [CC BY 2.0])

The trachoma elimination news mentioned at the beginning can be seen as the fruit of Papua New Guinea’s efforts described above. Trachoma often occurs in areas with poor water and crowded living conditions. The WHO recommends the “SAFE Strategy” (Note 5), which combines treatment and environmental improvements, to eliminate trachoma. Papua New Guinea’s innovation was to integrate the mass antibiotic administration component of the SAFE strategy with an existing program for another infectious disease, filariasis. By distributing medicines for filariasis and trachoma together in a single campaign, the country achieved mass drug administration (MDA). Addressing multiple infectious diseases simultaneously enabled efficient use of health personnel, logistics, and funding, and maximized opportunities for residents to receive care.

Going forward, it will be worth watching whether Papua New Guinea can achieve similar results against other tropical diseases. Nonetheless, challenges remain, including unstable funding, fragile pharmaceutical logistics, shortages of human resources, the dual burden of NCDs and infectious diseases, and population growth.

Note 1: Meanwhile, the western half of the island of New Guinea was a Dutch colony from the 1800s, became part of Indonesia in 1962, and also has an independence movement.

Note 2: The extreme poverty line defined by the World Bank is living on USD 2.15 per day. However, this line does not capture the reality of poverty. Therefore, GNV adopts an ethical poverty line of USD 7.4 per day instead.

Note 3: Pentavalent vaccine: a vaccine to prevent polio, pertussis, tetanus, Haemophilus influenzae type b (Hib), and diphtheria.

Note 4: Betel nut chewing: the practice of chewing the fruit of the areca palm wrapped with lime and betel leaf. Widely used as a stimulant in Southeast Asia and Papua New Guinea, it is associated with carcinogenicity, adverse effects on the digestive tract and oral health, and dependency.

Note 5: SAFE strategy: a four-pronged public health intervention—Surgery to prevent progression to blindness; Antibiotics to treat infection and prevent spread; Facial cleanliness to reduce infection risk; and Environmental improvement as a fundamental measure to prevent recurrence.

Writer: Kyoka Wada

Graphics: MIKI Yuna

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