Below is a formal-style PNG Government Cabinet Submission Paper based on the Chief Nursing Officer organogram and reform proposal.
🇵🇬 CABINET SUBMISSION PAPER
Establishment of the Office of the Chief Nursing Officer (Chief Nurse) and National Nursing Directorate Structure
1. Title
Establishment of a Chief Nursing Officer (CNO) Position and National Nursing Directorate to Strengthen Health Workforce Planning, Governance, and Maternal Health Outcomes in Papua New Guinea
2. Purpose of Submission
This submission seeks Cabinet approval for:
-
The establishment of a Chief Nursing Officer (CNO) position within the
National Department of Health Papua New Guinea - The creation of a National Nursing and Midwifery Directorate structure
- Approval of a strengthened governance and workforce planning framework for nursing and midwifery services nationwide
3. Background
Papua New Guinea continues to experience significant challenges in health service delivery, particularly in rural and remote areas. Key challenges include:
- Severe shortage of nurse-midwives in rural facilities
- Unequal distribution of health workforce across provinces
- High maternal and neonatal mortality rates
- Weak workforce planning and forecasting systems
- Limited use of health workforce data for decision-making
Current health workforce governance structures do not provide sufficient strategic leadership for nursing and midwifery workforce planning at national level.
According to the World Health Organization, strong health workforce leadership and governance are essential for achieving Universal Health Coverage and improving maternal and child health outcomes (WHO, 2016; WHO, 2021).
4. Problem Statement
The absence of a dedicated senior national nursing leadership structure has resulted in:
- Fragmented workforce planning
- Weak coordination of nursing education and deployment
- Limited data-driven decision-making
- Poor rural retention of nurse-midwives
- Inconsistent implementation of nursing policies across provinces
Without a centralised leadership structure, PNG will continue to face inefficiencies in workforce allocation and maternal health service delivery.
5. Proposal
It is proposed that Government establishes:
5.1 Chief Nursing Officer (CNO) Position
A senior executive-level position reporting directly to:
- Secretary for Health
- Deputy Secretary – Health Services
5.2 National Nursing Directorate
A structured division comprising five technical branches:
- Nursing Workforce Planning & Development Division
- Nursing Data, Monitoring & Health Indicators Division
- Nursing & Midwifery Clinical Services Division
- Nursing Education, Training & Professional Standards Division
- Nursing Policy, Regulation & Governance Division
6. Organisational Structure (Summary)
Secretary for Health
│
Deputy Secretary – Health Services
│
Chief Nursing Officer (CNO)
│
────────────────────────────────────────────
│ Workforce │ Data & M&E │ Clinical │ Education │ Policy
│ Planning │ Division │ Services │ & Training│ & Gov.
7. Objectives of the Reform
The establishment of the CNO and Directorate aims to:
- Strengthen national nursing and midwifery leadership
- Improve workforce planning and distribution
- Enhance rural retention of nurse-midwives
- Improve maternal, neonatal, and child health outcomes
- Strengthen health workforce data systems for decision-making
- Align nursing education with national workforce needs
- Improve governance and accountability in nursing services
8. Key Functions of the Chief Nursing Officer
The Chief Nursing Officer will be responsible for:
8.1 Workforce Planning
- National nursing workforce forecasting
- Staffing norms and distribution models
- Rural deployment planning
8.2 Health Information and Monitoring
- Nursing workforce data systems
- Monitoring of health indicators (maternal mortality, SBA rates, staffing ratios)
- Annual workforce reporting
8.3 Policy and Governance
- Nursing policy development
- Regulatory coordination with Nursing Council
- Alignment with National Health Plan
8.4 Clinical Leadership
- Oversight of nursing service delivery standards
- Maternal and newborn health improvement programs
- Quality and patient safety systems
8.5 Education and Professional Development
- Nursing curriculum alignment
- CPD systems
- Leadership development programs
9. Expected Outcomes
Implementation of this structure is expected to result in:
- Improved distribution of nurses and midwives across provinces
- Strengthened rural maternal health services
- Reduced maternal and neonatal mortality
- Improved workforce retention and reduced attrition
- Data-driven health workforce planning
- Stronger accountability and governance systems
These outcomes directly support Papua New Guinea’s National Health Plan and Universal Health Coverage objectives (National Department of Health PNG, 2021; WHO, 2016).
10. Financial Implications
Initial costs will include:
- Establishment of CNO Office and staffing
- Development of workforce information systems
- Provincial coordination structures
- Training and capacity building programs
However, improved workforce efficiency and reduced service duplication are expected to generate long-term cost savings.
11. Implementation Plan
Phase 1 (0–12 months)
- Approval of CNO position
- Recruitment and appointment
- Establishment of core directorates
Phase 2 (1–3 years)
- Development of workforce information system
- Implementation of staffing norms
- Provincial rollout of reporting systems
Phase 3 (3–5 years)
- Full integration into national health system
- Workforce optimization and policy refinement
- Expansion of rural retention programs
12. Risk Analysis and Mitigation
| Risk | Mitigation |
|---|---|
| Resistance to restructuring | Stakeholder engagement |
| Funding constraints | Phased implementation |
| Data system delays | Partner support (WHO, donors) |
| Workforce shortages | Training expansion and incentives |
13. Consultation
This proposal should involve consultation with:
- Provincial Health Authorities
- Nursing Council
- Training institutions
- Development partners (WHO, UNICEF, UNFPA)
- Health workforce unions and associations
14. Recommendation
It is recommended that Cabinet:
- Approves the establishment of the Chief Nursing Officer position
- Endorses the creation of a National Nursing Directorate structure (includes the 5 technical division positions)
- Authorises implementation of the proposed workforce planning and monitoring system
- Supports phased funding and implementation through the National Department of Health for the Directorate structure (6 positions).
15. Conclusion
Strengthening nursing and midwifery leadership through the establishment of a Chief Nursing Officer is a critical reform to improve health system performance in Papua New Guinea. This reform will enhance workforce planning, improve maternal health outcomes, and support equitable access to healthcare services across rural and urban areas.
References
National Department of Health PNG. (2021). Papua New Guinea National Health Plan 2021–2030. Port Moresby: Government of Papua New Guinea.
World Health Organization (WHO). (2010). Monitoring the building blocks of health systems. Geneva: WHO.
World Health Organization (WHO). (2016). Global strategy on human resources for health: Workforce 2030. Geneva: WHO.
World Health Organization (WHO). (2021). Global strategic directions for nursing and midwifery 2021–2025. Geneva: WHO.
United Nations Population Fund (UNFPA). (2021). State of the World’s Midwifery Report 2021. New York: UNFPA.
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