The interviews covered three main areas: users’ views of effective health services, current challenges affecting effective planning and management of primary healthcare services, and interventions to improve health services planning and delivery. Methods: Qualitative data were collected using semi-structured interviews with key informants (KI) representing academics, undergraduate students, administration staff, patients and healthcare workers. This qualitative case study aims to explore health service users’ perspective of effective health services delivery and the current challenges affecting the management and delivery of health services at a primary healthcare facility in Madang Province, Papua New Guinea (PNG). Introduction: Healthcare service is an essential determinant to population health. This paper is a study of how elections in Madang have been influenced by the highlands style of politics and how locals have responded. Standish (2002) describes similar situation in Chimbu as an ‘ethics-free zone’ where ‘candidates will do whatever it takes in attempting to grab state power …’ (p.28). And if they are unsuccessful, they try to disrupt the process and challenge the duly elected member. From observation the so-called ‘highlandisation of coastal politics’ is created by candidates who are determined to win at all cost and by whatever means to gain public office. Madang has lately been experiencing this style of highlands politics that has affected the elections process. Standish (2002) talks about the ‘Highlandisation’ of coastal politics where some features of highlands politics are now experienced in some coastal electorates. These candidates have brought with them the style of politics that is widely practiced in the highlands of PNG. Within the last decade an increasing number of candidates originally from the Highlands provinces have been contesting the Madang Open and Provincial electorates.
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