Transforming Health Care Leaders in Papua New Guinea

The typical career trajectory for health system leaders was for chief executive officer (CEO) positions to be filled by physicians who had reached the pinnacle of their clinical careers but lacked the opportunity to acquire the strategic skills of health systems leadership. By the early 2020s, this skills gap was manifesting itself in poorly managed health services, with wide variation in the performance across provinces. Without effective supervision and management, health facilities were operating at suboptimal levels due to lack of appropriate staffing and medical supplies. There has also been a significant gender imbalance in the health system senior leadership in Papua New Guinea, with low number of women in key leadership and decision-making roles at all levels.

In 2018, the Papua New Guinea government approved funding for middle management and executive leadership training as part of the Health Services Sector Development Program, a wider health systems strengthening effort to expand and improve rural health services. By late 2025, the program had trained health system managers in every province—more than 1,300 graduates—most of whom had not previously received any formal management or supervisory training.

Under the HELDP in 2023, training was delivered to health directors via intensive residencies in a face-to-face, problem-based learning modality, culminating in an overseas study tour. The program was demanding: it took directors away from their workplace for 2 weeks at a time. Trainees worked in groups that required them to put aside their status within their organizations and work with each other as equal collaborators, crucial to breaking down the siloed approach to management that has been holding back the health system.

For some of the senior clinicians, who are used to being the person to whom everyone looked for instructions, this was a challenging and humbling experience. On the other hand, those used to staying quiet were empowered to find their voice and actively participate. All graduates were required to work on a final project that would bring about change in their work setting.

Figure 1: The Health Executive Leadership Training Program

Click on image to enlarge. 
Source: Asian Development Bank.

By late 2025, HELDP had trained over 110 executives. Data gathered through interviews with 32 HELDP graduates, facilitators, and other stakeholders revealed that the training had been transformative for the graduates. Their managers described visibly improved leadership confidence, decision-making, and organizational performance. At an institutional level, there was evidence of better coordination and stronger alignment with national health strategies.

Graduates reported being better listeners, more solutions-focused, and better equipped to handle conflict resolution. Several graduates have moved into more senior positions, attributing their success to the training they received, which gave them the confidence to go for a promotion and helped them stand out and excel in the interview. This was particularly the case for some of the women who graduated from the training. They returned to their workplaces resolved to advocate for themselves and their ideas, and to be a role model for women in more junior positions.

Several graduates have initiated service delivery improvements at the health facilities they oversee, improved data use in planning, and enhanced team management and communication in their provinces. Both the clinical staff and the corporate and support services graduates have a greater appreciation for the work of the other, and a new recognition that they are all on the same team playing crucial roles in patient care, even when they are not patient-facing.

The program is expensive, though. It costs about $17,000 per graduate, in large part due to air transportation from the provinces to the capital and overseas. Graduates pointed out that the course sent them back better equipped to run their health system more efficiently, make better use of their existing resources, and support the aim of a healthier population, all of which have a financial benefit. Also, the study tour enabled them to see highly aspirational practices, such as robotics in a pharmacy in Singapore, and tools that they could immediately implement back home, such as clinical governance processes seen in Australia.

However, not everyone found fertile ground for the new ideas they came back with and their enthusiasm for change fell afoul of others’ unwillingness to change. Some graduates lacked support when they tried to implement in their provinces the change management projects they designed during the course because of resistance or opposition from their provincial health CEOs. This was less common in settings where there was a supportive CEO and where there was critical mass of HELDP graduates, who could then drive an agenda of strategic vision and change.

Double the number of HELDP graduates. Although there is no magic formula to determine the critical mass of graduates needed within a single organization to transform its leadership, graduates have found that the impact of their individual training is greater than the sum of its parts when they work together with fellow graduates.

Provide training to the provincial health CEOs. A bespoke leadership training program for CEOs, pitched at a more strategic level and run over a shorter time (such as a period of 3 weeks), could reinforce the impact of the HELDP.

Build domestic capacity to deliver leadership training. Institutionalizing HELDP within a university, as a recognized postgraduate qualification, and a pathway to an in-house postgraduate diploma or master’s degree would promote sustainability.

Support additional online learning. While the face-to-face, intensive and residential modality, combined with overseas exposure, is unique and highly effective, this training could be augmented with online programming if trainees were supported to access better online connectivity.

Foster intra-provincial mentorship. This could be in the form of a rotational program, for example, with graduates coming in to understudy CEOs around the country.

Asian Development Bank. 2026. Equipping Health Care Leaders in Papua New Guinea: Capacity Building for Future Health Executives and Better Health Outcomes.