Pasifika Medical Association’s Debbie Sorensen on Radio Australia

Fiji and Papua New Guinea are facing a shortage of doctors. Groups representing doctors in both countries say their governments need to do more training, and ensure there are incentives to retain them.

Presenter: Catherine Graue

Speaker: Debbie Sorensen, Chief Executive, Pasifika Medical Assocation
SORENSEN: Health rates of illness and disease, and indeed deaths, they are really quite poor in remote areas in Papua New Guinea and across PNG in general and so having access to good quality medical staff is really critical to work with your local healthworkers and other volunteers in the rural areas, in the village health offices, health promotion workers. And so I think that doctors provide a really critical role in leading those health teams and providing good quality care out in the remote areas.

GRAUE: Do we have any clear information about just how many doctors there are or aren’t I suppose it must be out in rural and remote PNG?

SORENSEN: Well, in right across the Pacific region, doctors are in short supply and high demand and that is a result of a number of issues, really constrained health budgets in all of the countries, so the ability indeed if you had a realistic level of medical staffing, the ability for a health system to then be able to employ and pay doctors is really quite difficult, the education systems. We have our young people really being educated to a level, at a secondary level to be able to enter into tertiary study and complete a medicine course.

PNG, of course, is very lucky because it has it’s own very good medical school there based in Port Moresby, but the constraints are both a human resource constraint and a financial constraint in countries right across the region.

GRAUE: I understand in PNG at the moment, it’s about only 45 new doctors being trained each year. Is that because that’s the only amount that they can afford, or, as you’ve just mentioned, there are a limited number of students graduating from high school that are able to go on to tertiary education?

SORENSEN: I think it’s both of those things and that the amount that the medical school has funded in terms of the intake and secondly, as you say, there is an issue in terms of spread between secondary school education and going into tertiary study, as there is in New Zealand and Australia for indigenous and Pacific students. And so if we were to really address the workforce shortages across the region, we would be looking at the education systems and how to get our young people doing more science and maths, at a high level that would then allow them to go into medical school in perform really well and, of course, making available more places in medical schools for the medical schools to be able to train more people. And then, of course, the career paths after that, because that’s just the beginning of a longish journey  of course, for doctors.

GRAUE: Yes, and now in Fiji, there is also a medical school there and yet Fiji’s also facing a doctors shortage. It’s Medical Association says that’s because many skilled and senior doctors are leaving for better opportunities overseas. This is a story we’ve heard many times before. So how can it be stopped, how can we change it?

SORENSEN: Yes. Indeed, in Fiji, as you say doctors are very well trained and they are in demand and these days the graduates, particularly those who have completed their Masters training, which is the equivalent of a specialist training are in high demand and so what we are seeing now is as the wages and salaries and conditions are slowly rising across the region, doctors in the Pacific, whether they be trained in PNG or at the Fiji National University are able to compete for positions and a lot of our locally trained doctors are now filling aid positions, which are paid at a relatively high salary, for example, somewhere between 80 and 100-thousand dollars a year filling aid positions in other countries. Vanuatu would be an example of that where the Australian Aid program is working very hard around a workforce development program to really support our local commissions there and in the last couple of years, they have had 5 or 6 fully trained specialists ni-Vanuatu specialists come back into the country and are practicing there now. So we slowly see the change right across the region with our own doctors being trained, coming home and working. But it still is going to require quite substantial support in terms of looking at the changes in salaries, in conditions, in countries, access to ongoing training for doctors, the ability for them to go to conferences, both within the region and internationally, and also support in the health systems and the health systems right across the region are really, continue to be developing and at times quite vulnerable.

GRAUE: You’ve mentioned there the Fiji doctors heading to Vanuatu, being lured by better pay. That’s exactly what the Fiji’s Medical Association is saying needs to be done in order to retain their skilled doctors, is that to retain them, they need to improve the pay, the conditions, etc. for their local doctors. But is the Fiji government able to afford that within its health budget?

SORENSEN: Well, I think that is a challenge for all governments in the Pacific. It’s really not a challenge that we are unfamiliar with in New Zealand and Australia with our own specialists and doctors.

I think it is very difficult and it’s particularly compounded by the fact that in most Pacific countries, salaries and conditions are controlled by Public Service Commissions as opposed to Departments of Health or Ministries of Health and countries are quite challenged by the notion that doctors might be paid more, for example, than other categories of professional staff in the country. And so some doctors there salary rates are really very, very low. For example, if we use the example of Vanuatu again, they’re average salary is somewhere between 20 and 25-thousand Australian dollars a year.

GRAUE: And we’ve also seen in Vanuatu, this week, a real health crisis where it’s been revealed that the entire 2014 health budget has been exhausted in just the first 6 months this year and many doctors had their contracts expire at the end of June and they have no idea if they are going to have another contract, if there’s the money for that, and yet they are still turning up to work. It would seem that many of these health professionals, nurses as well, are still committed obviously to their jobs and doing things, despite the fact, and staying at their jobs, despite the fact that they aren’t being remunerated?

SORENSEN: That’s absolutely right and the cultural context, working in medicine, whether you are doctor or a nurse or a health worker, For us, it’s service to our communities and our families and so even though the conditions are very challenging, even though work is extremely demanding, much more demanding than working in the health services in New Zealand or Australia, even though as you say, in a number of countries for quite long periods of time, people are often not paid at all. They will still come to work to serve their communities, their families and their people. And so that level of commitment really is something that can be built on and encouraged, but it is very challenging. I think one of the other issues in the region is around the support for Ministers of Health of health and health systems in general.

AusAID has been doing very good work around the region, in a number of countries, Tonga, would be an example, where they have been working for a number of years in terms of strengthening the health system.

So it’s very complex situation in health at a combination of your workforce and how do you encourage, retain and continue to recruit high quality staff, it’s your health systems and your management. How do you develop the health system infrastructure, your facilities, your technology and how do you also develop your health managers, your policymakers, your administrators, because, of course, they are often the people that are responsible for overseeing the care of your health workforce.

And, of course, loaded onto that is the political situation, health in any country, is a political issue and the changing kind of political landscape in any country has an impact on your health system, whether that be changing elections, frequent changes of Ministers of Health, changes in your officials. So it’s a very challenging environment to work in.