A review of health leadership and management capacity in Fiji

Type Report
Title A review of health leadership and management capacity in Fiji
Publication (Day/Month/Year) 2011
Publisher University of New South Wales Human Resources for Health Knowledge Hub
City Sydney
Country/State Australia
URL https://sphcm.med.unsw.edu.au/sites/default/files/sphcm/Centres_and_Units/LM_Fiji_Report.pdf
This review describes the current situation of health leadership and management capacity at the sub-divisional level in Fiji. Fiji is a lower middle-income country ranked 86 out of 169 countries on the UNDP1 human development index. With a gross national income per capita of USD$4,304 in 2007, Fiji’s economy is among the most developed of the Pacific Island countries. However, the economy contracted by 2.5% in 2009, representing the worst performance in more than a decade.

Fiji has a good standard of health with about 70–80% of the population having access to Primary Health Care. Life expectancy at birth is around 70 years, similar to most Pacific Island countries. Infant mortality has declined over recent years from 21 per 1000 live births in 2005 to 13 per 1000 in 2008. Fiji now faces significant challenges with increasing rates of non-communicable diseases and injuries from accidents. Non-communicable diseases such as diabetes, heart disease, high blood pressure, respiratory diseases and cancers, have replaced infectious and parasitic diseases as the principal causes of mortality and morbidity in Fiji. The health system of Fiji is the most complex and developed among the Pacific Island countries. The Ministry of Health (MoH) is Fiji’s largest provider of health care, but a growing private sector and a significant number of non-government organisations also provide particular services to the public. In 2010, the MoH had an approved establishment of 3,452 employees, 17% of whom were medical or dental cadres, 57% nursing, 15% other health professionals and 9% administration and information technology (IT) support. Government health spending as a proportion of gross domestic product (GDP) was 2.6% in 2008. This was relatively lower than allocations in neighbouring Solomon Islands and Tonga, which were between 4–5% of GDP respectively. The Fijian Government expenditure on health represented about 71% of total national health expenditure in 2008. In general, donors finance less than 5% of health
activities in Fiji, making the health system one of the least donor-dependent in the region. Fiji is divided into four divisions and 15 provinces. Health services are delivered in the four divisions but through 19 sub-divisions, all of which have health centres and nursing stations and 16 have a sub-divisional hospital. There are 19 sub-divisional medical officers (SDMOs) working as clinicians at the sub-divisional level who also have responsibility for the day-to-day management of the health system. Their managerial competencies vary according to the level of management preparation. While all are medically trained, only four of the 19 reportedly held a Master of Public Health Degree in 2010, in which they had studied basic management. The MoH and the Public Service Commission (PSC) and donors periodically provide short management training courses and workshops. In conforming to MoH, PSC and Ministry of Finance process, the degree of management flexibility is limited. The MoH itself has undergone periods of decentralisation and recentralisation in the past three decades which has significantly altered management flexibility in the divisions. Key management support systems at the divisional and central levels give variable support to SDMOs. Sub-optimal systems, such as the supply of essential drugs, have periodically required high level management reviews instigated by the Minister. SDMOs have managerial flexibility in managing their interaction with the local community. Effectiveness in this domain depends on the ability to balance roles while also motivating community leaders to undertake preventative measures, such as early referral, improved sanitation and non-communicable disease risk factor control. Role definition, staff team building and community development competencies require further strengthening as Fiji accelerates its progress towards achieving the Millennium Development Goals (MDGs).

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