At Wagbel village at the edge of  Mt. Hagen City,   22-year-old nurse,  Roselyn Pakil’s work  day has started.  As early as  8am, the first lot of patients have begun arriving   bringing with them various medical complaints.  
Rosleyn Pakil  represents the first layer in  the Western Highlands provincial Health system.  At this makeshift clinic,  she treats patients with minor complaints  and refers only the serious cases to Mt. Hagen General Hospital.
“I’ve been working here for 8 months,” she says. “At first when I came, there weren’t many patients. But then  more people came.”
Four years ago, the Western Highlands, became one of the first provinces  to trial the  Provincial Health Authority concept.   It is a design that brings together previously fragmented services and functions under a single  authority. 
The man driving the transformation is Dr. James Kintwa, who was previously  Chief executive of  Mt. Hagen General Hospital.    He later become Chief Executive of the Provincial Health Authority  bringing with him  experiences  and lessons learnt from his term as hospital CEO.
            “When we started we looked at developing a health service plan. A health service plan  that concentrated on the national health model that had different levels of service.
            The Health Authority  has  focused on building capacity   at the district level with  multiple layers of coordination  all reporting ultimately to the Chief executive.
Previously,    the  provincial Hospital operated as an entity separate from  the provincial and district  health system.    That resulted in  poor coordination,  less efficient use of resources  and a highly fragmented health delivery system didn’t  meet national  health expectations. The compartmentalization of services  meant that resources that could be used collectively  remained underutilized es
In a country  with some of the most rugged terrain in the world and some of the most isolated populations, a fragmented health system  was practically  ineffective even with enormous amounts of donor funding coming from various sources.
            Under Dr. James Kintwa as CEO, the provincial Health Authority has been able to provide a clear vision  and  framework   to both donor partners  and health staff in the province.
While the Health  Authority remains a government agency, it relies  heavily on support and cooperation from  churches and non-government agencies.  Three district health centers in the Western Highlands  are  operated by the  churches and NGOs.  It is  set of partnerships that are  working  well for the provincial health authority.
            “In this period of the national health plan, the two key reforms were: the Provincial Health Authority reform  and the Community Health Post Reform.”
            The Wagbel community has gone a step further.  
Samuel Ropkil, landowner  and community leader   recently gave up a third of his traditional land   for the construction of  a community health post.
He also gave up his house  to be used as a  temporary health clinic and that  is where Nurse Roselyn Pakil  has come to work everyday for the last eight months.   
Ropkil    given that the health was a big concern for his people,  he decided to allow his land to be used for beneficial development.
Mr. Ropkil has since moved out of his house and is in the process of constructing a new house on another portion of his land. 
At recent national health meetings,  the western Highlands has moved up the health  system rankings  to number one placing  in  health service delivery.   
Another one of the building blocks to  their success  has been strong political support from Western Highlands governor, Paias Wingti  and other members of parliament from the Western Highlands. 
BUT as a growing health system,   there are increasing challenges:  An aging workforce and an education system that is not  producing enough  nurses and doctors for their growing needs.


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