In this review we reflect upon the papers within this focus issue of the Papua New Guinea Medical Journal on the theme of health system strengthening, and provide a summary of lessons learnt and ways forward from the lessons and experiences of the past. Priority areas have been identified for consideration by the health sector and its various players and stakeholders moving forward, particularly in the context of the next National Health Plan. The imperative need to focus on the basics is emphasized: to make sure that key health interventions are implemented; that health workers have requisite skills and are placed where services are needed; that there is an uncompromising focus on ensuring, by whatever means, that the essential logistical elements are there to enable the health worker to provide the interventions; that key messages are communicated to, and provide support for, communities to attend care and practise health-promoting behaviours; and that population coverage is increased. The need for a long-term, systematic approach to getting the basics in place is essential. In developing and implementing this approach, caution needs to be taken with regard to confusion between means and ends. It is important to maintain focus on the desired outcome--improved health of Papua New Guineans; and to use, but not be distracted by, the means for getting there--including the various health sector reforms being implemented. It is essential to identify and focus on ways in which the existing capacity within the system can be harnessed, and to ensure that the environment supports the effective and efficient use of existing capacities. The capacity of the health sector--and the careful, measured use of partnerships--to extend service delivery to underserved populations is discussed in broad terms.

How members of the community perceive and respond to diseases and health problems are important variables to take into account when planning interventions and priorities in a health system. This paper summarizes some qualitative research undertaken in 2001 and 2002 in Papua New Guinea as part of the formative research for health promotion activity development for immunization, maternal health, tuberculosis and malaria services. It provides some highlights of the health beliefs and health-seeking behaviours amongst a range of urban and rural populations in a range of provinces in Papua New Guinea (PNG), and across a range of age groups including young adults. The findings reinforce that these health-related issues are seen by most of the population as important, although maternal health lags behind, especially in male respondents' perspectives. However, how they respond varies often with the planned health system interventions, and these differences need to be understood and addressed in order to increase the acceptability and efficiency of health services in PNG.