Using the socio-ecological model to appraise the implementation of Provincial Health Authority in rural districts of Madang Province, Papua New Guinea: a qualitative study

Early Abstract:

Introduction: Globally, policymakers are adopting novel healthcare models to deliver health services. This study focused on understanding the viewpoints of health workers and local communities regarding socio-ecological factors such as community involvement, resource allocation, and leadership dynamics that influence the execution of the Provincial Health Authority (PHA) model in rural districts of Madang Province, Papua New Guinea.
Methods: The study employed   an exploratory qualitative study design to explore deeper insights into health workers' perceptions, views, and the process of delivering rural health services. Data were collected using semi-structured interviews, focus group discussions, and field notes with 30 participants: 15 clinicians, six community leaders, and nine policymakers across three districts in Madang Province from June to December 2024. These discussions were guided by the socio-ecological model, which provided a comprehensive framework for analysing the emerging themes.
Results: The article offers fresh insights into the socio-ecological elements influencing the execution of essential health policies. Participants highlighted several key themes, such as their optimism and hope for continued support, which serve as a source of inspiration (intrapersonal). Other themes include the challenge posed by the PHA's limited impact at the sub-national level, the necessity to promote multisectoral partnerships and shared resources (interpersonal), capacity management in rural health facilities (institutional), strategies for engaging communities (community), a restrictive policy framework that limits collaboration between the PHA and the District Development Authority, and the collective responsibility to tackle the fragmentation of roles at the sub-national level (policy).
Conclusions: The study's findings have significant implications for policy-makers and implementers in the rural districts of Madang Province. They underscore the importance of recognising and addressing the socio-ecological factors that influence the PHA model at all levels of the healthcare system. By enhancing leadership and management and effectively translating policy into health service delivery, health authorities can create a promising future, significantly improving health services in rural areas.
Keywords: district development authority, health policy, Papua New Guinea, provincial health authority, rural health services, socio-ecological model.