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Citation Information

Type Working Paper - Health Policy and Health Finance Knowledge Hub, The Nossal Institute, University of Melbourne
Title Non-communicable diseases and health system responses in Fiji
Publication (Day/Month/Year) 2013
URL http://ni.unimelb.edu.au/__data/assets/pdf_file/0010/852949/User_kelseym_WP_34.pdf
Fiji is well advanced on disease transition, with noncommunicable diseases (NCDs) now the main cause of death. All sub-groups of the population appear to be affected. The Ministry of Health’s considerable efforts to tackle NCDs include development of national NCD strategies and increased funding and expansion of diabetes services. This has been complemented by additional resources from donors such as AusAID, and technical support from a variety of organisations. A newly developed tool (Robinson and Hort 2011)
was used to describe and assess Fiji’s health system response to NCDs. Its four dimensions assessed preparedness in building commitment, reorienting policies, developing new service delivery models and ensuring equity against four descriptive levels of readiness. The piloting of this framework in Fiji is reported here based on a desk review and informed by consultation with selected individuals. An initial literature search included regional and international reports from the WHO and World Bank, MOH data and documents from the Ministry of Health and Bureau of Statistics.

Following assessment of these, the framework was used to assess Fiji’s progress. The assessment showed inconsistent progress. In building commitment and addressing health system constraints, it showed strong progress, with high-level commitment, efforts to secure sustainable funding and strategic planning. There was slightly less progress in public policy on population health promotion. Efforts were found to use policy approaches outlined in strategic plans, and to engage the community and private sector.

Progress for service delivery models and equity was very limited. No evidence was found of specific actions to ensure equity of services or health-related financial support structures for low-income households. In the delivery of health services for NCDs, evidence of progress against the framework indicators was absent, although other actions were found. There appeared to be limited consideration of how to integrate NCDs into existing primary healthcare services. There was little evidence of targeting high-risk groups or proactive engagement with the private sector. Expansion of indicators under the service delivery element may be of value to increase the scope of this assessment. It may also be valuable to consider participatory approaches to completing this framework.

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