Papua New Guinea isn't a place you necessarily want to linger. Its capital, Port Moresby, ranks among the most dangerous and least liveable cities in the world. Tribal fighting and sexual violence against children mar the provinces. In some areas, women accused of witchcraft are still bashed or burnt alive.

This is happening 500 kilometres from Queensland.

Australia gives $550 million a year to our nearest neighbour; it's more than we give to anyone else and more than any other donor to PNG. Critics of development assistance often ask the question: "What does our money achieve?" And PNG is a perfect illustration of the confusing answer: development aid is making a tangible difference in people's lives, and yet the big picture remains relatively unchanged.

Despite massive growth in gross domestic product, the country has flatlined at the bottom of the Human Development Index. In 2012, PNG ranked 125 out of 128 countries on The Economist's index of women's economic opportunity. According to Save the Children, there are regions in which 75 to 100 per cent of women experience some form of physical violence.

In Tari, capital of the mountainous Hela province about 600 kilometres north-west of Port Moresby, we meet a woman who has survived the impossible. Armed with a machete, her husband hacked off one of her arms and her legs, before removing her scalp. Every month, the family support unit at the Tari hospital meets up to 100 new women and children who are victims of sexual and physical violence.

The nurse who runs the clinic is a small, unassuming woman named Clare Lembo. "According to Hela culture, men are the head of the community, head of the family," she explains. "Women have no rights. Women will just sit there and listen to the men only. Sometimes if a woman was to speak out and say: 'I'm also like man, I have every right', the man has the power to beat them up."

These days the hospital is effectively managed by an oil company. When Medecins Sans Frontieres pulled out in April last year, the Oil Search Foundation took over. Oil Search is one of PNG's largest firms, at one point accounting for 13 per cent of the country's GDP. In addition to control of the country's oilfields, it maintains a 29 per cent stake in ExxonMobil's $US19 billion PNG liquefied natural gas project, which supplies 8 million tonnes of gas annually to China and Japan.

Managing director Peter Botten, sometimes called "the No.1 man in Tari", now chairs the hospital board. In the first nine months of 2016, we are told, the ramshackle hospital performed a staggering 635 serious surgeries, dealt with 26,305 outpatient presentations and had its budget increased to $6 million in order to become a regional hub for 400,000 people.

Botten tilts his head. Twenty minutes down the road, amid this entrenched poverty, is one of the biggest gas fields in south-east Asia. He concedes the benefits of this do not always reach people on the ground. "One of the fundamentals of PNG is you actually have to bring communities along with you," Botten says. "If we get this wrong, we will be shut down."

Stephen Howes, a former chief economist at AusAID and now the director of the Development Policy Centre at ANU, is nonplussed about the reliance on corporate charity. "It may not be ideal but in the circumstances it's great," he says. "PNG is a very resource-rich country - it is going to have these big resource projects and you want those companies to contribute."

At a library opening at Kuluanda Primary School, parent Doreen Pipiki thanks Oil Search for her ongoing job at Tari hospital, where she works in family planning. It's an especially important task given the hospital does not perform terminations. Her own daughter Marianne-David is in the fifth grade and achieving solid results. But most children here don't start school until they are seven or eight years old. By then, says Pipiki, "it's too late".

Those who start school are extremely unlikely to finish. Statistics can be difficult to nail down in PNG, but it is estimated just 2 per cent of children who start year 1 will go on to complete year 12. "I think that's really alarming," says 22-year-old Johnetta Lili, an accounting student at the University of Papua New Guinea. Her friend Jollanda Methew is the first in her family to go to university. Both study at a new business faculty headquarters funded by Australian aid.

Men might dominate PNG's power structures, but on the ground, it's women who are doing the hard yards. Women like the softly-spoken Martina, who lives in the impoverished Nine Mile settlement outside Moresby, and sells her crops at the local market each morning to support her parents and daughter Angeline. Women like Esther Mwayemwanna, a teacher for 31 years and principal of Caritas Tech, a Catholic secondary school for girls who have fallen out of the public system.

And women like Lucinda Gulluman-Kisip, who helps establish libraries for preschool children. "There's a lot of change happening," the 39-year-old says over a meal on the flight back to Port Moresby. "A lot of the things we're doing are against the traditional practices. We're seeing a lot of women taking on work and being breadwinners, even. It's really hard for a Papua New Guinean man for his wife to be a breadwinner. It does create - how should I say this - conflict between the new and the old."

Continuity and change, perhaps. It is evident at the Duffy Cafe in Port Moresby, a regular hangout for diplomatic types. It's easy to see why: cold-drip coffee and avocado on toast make it a veritable home-away-from-home for Australians. But this oasis can only exist in a heavily-guarded compound, behind two sets of security gates, such is the omnipresent danger of Moresby's streets.

At the Boroko police station and remand centre, cops dressed immaculately in patent leather shoes proudly lead us around the redeveloped cell block. There are still no beds and no mattresses. As many as 15 people will be interred in each cell, for as long as two or three months, a constable says. Outside the station, two women shelter from the heat under a gazebo, waiting to talk to the police. They have come to report - again - their husbands' violence.

Siniva, 24, says her husband flies into a jealous rage if she so much as acknowledges another man on the street. "If I'm smiling or if I say hello, when I go back to the house he hits me," she says. "He cuts me with [a] knife, both my thighs. I always go to police station but they don't help me."

Macklyn, 25, is beaten weekly by her husband. "He says that I'm a lousy wife, I have no money. He doesn't want to sit down and listen," she says. "He always tells me that he will never change."

In just a few days in PNG, Fairfax Media meets countless women who have survived violence and are now working to stop it. But there's also an uneasy question: where are the men? One of the politicians in our delegation, Victorian Nationals MP Damian Drum, makes the point during a briefing with Oxfam.

"This is not a women's problem. It's a man's problem," he says. "We can't have women telling men they have to change their behaviour -we need to have men telling men."

Ian Lapu, a case manager at Oxfam, is trying to do exactly that. In his workshops and conversations with men, he talks about the law and human rights - a foreign concept for many of his compatriots. He appeals to their sense of nationalism: treat women with respect and they will raise healthy children, the country's future custodians. It's an odd pitch but apparently it works.

"Everybody wants to make world a better place," Lapu says. "But they will not make the world a better place until they end violence."

Tackling gender inequity is one of the key pillars of Australia's aid program in PNG, and the ANU's Howes says we can take credit for "positive trends" in getting the problem taken seriously. In other areas it's a mixed bag. ANU research found between 2002 and 2012, educational outcomes improved, with more teachers, better classrooms and more children going to school. But the health system went backwards at the same time.

The massive GDP growth that accompanied the liquefied natural gas boom has given way to collapsed commodity prices, a fiscal crisis and a country that cannot fund basic services. Howes wants more Australian aid to go directly to NGOs, churches and even the PNG government. Otherwise, he warns, the program runs the risk of building infrastructure the country cannot support in the long-term.

Howes cautions against lofty expectations for what is, at $550 million, not a huge amount of money. "As long as PNG is struggling, it's going to be hard to view the aid program as a success, no matter what it does," he says. "We can't save PNG. That shouldn't be the aim. PNG's destiny is in its own hands."

The writer travelled to Papua New Guinea courtesy of Save the Children.