Illuminating the local: can non-formal institutions be complementary to health system development in Papua New Guinea?

This paper offers a fresh insight into the performance and reform opportunities of the formal health system of Papua New Guinea. A central tenant of this paper is that the historically imposed and continuing top-down nature of the formal health system in PNG is not capitalizing on potentially positive incentives and motivations inherent in the broad range of non-formal institutions that frame the PNG health system.    The paper suggests that an enhanced understanding of these non-formal institutions may provide clues for how the formal system could be reconfigured to better align with the non-formal. The opportunity offered by this approach is to leverage the energy, motivation and legitimacy inherent in non-formal institutions to better buttress or infuse the formal health system. The paper draws on an emerging body of development thinking that recognises that development depends on institutions that are stable, fair, legitimate and flexible enough to reflect political pressures; and that in turn, these kinds of institutions are the product of the interplay of formal and informal institutions. In particular, this theory argues it is when informal institutions are “complementary” to formal institutions that institutions are likely to be most effective. In these situations informal institutions support the formal institution through “filling in gaps” either by addressing contingencies not dealt with in the formal rules and/or by facilitating or creating incentives for individuals to pursue the goals of formal institutions. The paper analyses the PNG health system through the lens of this non-formal institutional framework