Disbursement,decentralization and development: Lessons from the first rural health services project in Papua New Guinea

In 1983 the Department of Health in Papua New Guinea decentralized the control of health services to provincial governments. In the same year a major rural health development project commenced in six of the nineteen provinces. Conflict arose between the centralized control required by the project and the decentralized health system. This article reviews the experience of the project implementators in trying to reconcile the philosophy and reality of decentralization with the centralized project design. Lessons point to the need for closer collaboration with beneficiaries during project design, formal clarification of responsibilities of national and provincial governments in implementation, institutional strengthening as a project input and the development of mechanisms for review and change during the course of implementation.